Unit 2 test Questions Flashcards
You are scanning a patient with a known mass in the left medial segment of the liver. What anatomic landmark can you use to identify the left medial segment separate from the right anterior segment of the liver?
a.Left portal vein
b.Ligamentum teres
c.Ligamentum venosum
d.Middle hepatic vein
e. Left hepatic vein
Middle hepatic vein
You suspect enlargement of the caudate lobe in a patient with liver disease. What structure located at the anterior border of the caudate lobe will help you identify this lobe of the liver?
a. Left portal vein
b. The ligamentum venosum
c. Inferior vena cave
d.The ligamentum teres
e. Main lobar fissure
The ligementum venosum
Which vessel courses within the main lobar fissure?
a.Main portal vein
b. Left portal vein
c. Middle hepatic vein
d. Proper hepatic artery
e. Right hepatic vein
Middle hepatic vein
Oxygenated blood is supplied to the liver via the:
a. Portal vein and hepatic vein
b.Hepatic vein and hepatic artery
C.Hepatic vein and portal vein
d. portal vein and hepatic artery
e. Hepatic artery only
Portal vein and hepatic artery
You are performing a sonogram on a slender female and notice a long, thin extension of the inferior aspect of the right lobe of the liver. This most likely represents:
a. Caudate lobe
b. Quadrate lobe
c. Reidel’s lobe
d. Accessory liver
e. Papillary projection of the caudate lobe
Reidels lobe
You are performing an ultrasound exam of the liver on a small patient with a 5 MHz curved linear array. Although you have increased the overall gain to its maximum setting, the posterior border of the liver and diaphragm are not visualized. What should you do?
a. Call the service representative to repair your equipment.
b. Decrease the transmit power on the ultrasound unit.
C. Move the focal zone into the near field.
d. Rescan the liver with a higher frequency transducer.
e. Rescan the liver with a lower frequency transducer.
Rescan the liver with a lower frequency
Which of the following correctly describes the probe placement and imaging plane you would use to demonstrate the three hepatic veins and inferior vena cava in one view?
a.Transverse subcostal approach with the probe angled superiorly and to the patient’s right
b.Transverse intercostal approach with the probe angled inferiorly and to the R patient’s left
c.Intercostal approach with the probe oriented in the coronal plane
d.Subcostal oblique approach with the probe angled inferiorly and to the patient’s left
e.Sagittal subcostal approach with the probe just to the right of midline
Transverse subcostal approach with the probe angled superiority and to the patients right
A patient is referred for ultrasound evaluation of a questionable mass in the dome of the liver seen on a CAT scan. Which method below would improve visualization in this area of the liver?
a.Perform a subcostal scan with the probe angled superior and the patient in deep inspiration.
b.Perform an intercostals scan with the probe in a coronal plane and the patient in expiration.
c.Perform a subcostal scan with the patient performing a Valsalva maneuver
d.Roll the patient into a right lateral decubitus position and scan from a
subcostal approach with the patient in expiration.
examina
e.The dome of the liver cannot be seen with ultrasound.
Perform a subcostal scan with the probe angled superior and the patient in deep inspiration
Which of the following lab tests is NOT used in evaluation of liver function?
a.Gamma-glutamyl transpeptidase (GGT)
b.Aspartate aminotransferase (AST)
c.Direct bilirubin
d.Indirect bilirubin
e.Lipase
Lipase
A liver ultrasound on a 49 year-old obese male demonstrates difuse increased echogenicity with a focal hypochoic area anterior to the portal vein. You can’t penetrate to the liver. This most likely represents:
a. Liver cirrhosis with hepatocellular carcinoma
b. Hydatid disease
c. Fatty liver with focal sparing
d. Metastatic disease most likely due to a colon primary
e. Normal liver parenchyma with a simple cyst
Fatty liver with focal sparing
You are scanning a patient with suspected liver cirrhosis. All of the following are sonographic features of cirrhosis EXCEPT:
a.Surface nodularity
b.Shrunken caudate lobe
c. Altered echo texture
d. Ascites
e. Regenerative nodules
Shrunken caudate lobe (caudate lobe spared with cirrhosis)
A patient is referred for a sonogram of the liver to rule out metastatic disease.
Which of the following describes the sonographic appearance of liver metastasis?
a. Single hypochoic mass
b. Multiple Hyperechoic masses
c.Masses of mixed echogenicity
d.Cystic masses
e. All of the above appearances of liver metastasis may be encountered
All of the above
Which of the following is NOT a feature of hepatic cysts?
a. Thin wall
b. Posterior acoustic enhancement
C.Anechoic
d.Increased attenuation
E. Increased through transmission
Increased attenuation
Which of the following is NOT true regarding cavernous hemangiomas?
a. Small, well-defined, Hyperechoic masses
b. Consist of a vascular network
c. More common in women than men d
d.Usually asymptomatic
e. Show prominent, high-velocity color Doppler signals
Show prominent, high velocity color Doppler signals
What significant complication following liver transplantation is NOT detectable with ultrasound?
a.Rejection
b.Malignant disease
c.Hepatic artery thrombosis
d. Portal vein thrombosis
e. Pseudoaneurysm
Rejection
A patient is referred for abdominal ultrasound with a high fever and right upper quadrant pain. You document the presence of a mass with low-level internal echoes and poorly defined borders. The mass is located in the right lobe of the liver, adjacent to the capsule and shows increased through transmission. This most likely represents:
a.Hemorrhagic cyst
b.Abscess
c.Hematoma
d. Choledochal cyst
e. Loculated ascites
Abscess
The most common form of malignant disease of the liver is:
a Hepatocellular carcinoma
b. Angiosarcoma
c. Cholangiocarcinoma
d.Metastatic disease
e.Primary lymphoma
Metastatic disease
You have been asked to perform an ultrasound to rule out the presence of Budd-Chiari syndrome. You will tailor your exam to include which of the following?
a.Volume measurement of the spleen
b.Doppler analysis of the hepatic venous system
c.Both supine and upright views of the porta hepatis
d.Oblique view of the right lobe of the liver to include the right hemidiaphragm
e.Careful search for periaortic lymphadenopathy
Doppler analysis of the hepatic venous system
Buddy Chiari syndrome is clotting in the hepatics
You are performing an ultrasound on a patient with a transjugular intrahepatic portosystemic shut (TIPS). What two vessels are connected with the TIPS stent?
a.Portal vein and hepatic artery
b.Hepatic artery and hepatic vein
c.Hepatic vein and inferior vena cava
d. Portal vein and hepatic vein
e.Portal vein and inferior vena cave
Portal vein and hepatic vein
You are scanning a patient with liver cirrhosis and suspected portal hypertension.
In this study, assessment of the size of which of the following is most important?
a.Spleen
b.Common bile duct
C.Abdominal aorta
d.Right hepatic vein
e.Inferior vena cava
Spleen
- A recannalized paraumbilical vein may be seen as a result of which of the following?
a.Hepatic adenoma
b.Portal hypertension
c. Hepatitis
d. Hepatic trauma
e.Liver biopsy
Portal hypertension
The ligamentum venosum forms the anterior border of what lobe of the liver?
a.Left lobe
b.Reidel’s lobe
c.Right lobe
d.Caudate lobe
e.Quadrate lobe
Caudate lobe
Which measurement below is the diagnostic cutoff for portal vein enlargement?
a.13 mm
b.5 mm
C.10 mm
d. 1.8 cm
e. 9 mm
13 mm
You are scanning a patient with an enlarged caudate lobe and shrunken right lobe.
What diffuse liver process should you suspect?
a.Cirrhosis
b.Acute hepatitis
c.Fatty infiltration
d. Candidiasis
e. Hepatocellular carcinoma
Cirrhosis
In what anatomic variant is the fundus of the gallbladder folded over the body?
a.Choledochal cyst
b.Phrygian cap
c.Duplicated collecting system
d. Biliary atresia
e. Junctional fold
Phrygian cap
A patient is referred from the emergency room to rule out acute cholesystitis.
You think the gallbladder wall may be thickened. What is the normal diameter of the gallbladder wall?
a.< 3 mm
b. <.5 mm
c. <35 mm
d. >3 mm
e. >3cm
< 3mm
You have a patient scheduled for a gallbladder sonogram. What preparation is required? a.
a.There is no necessary preparation for a gallbladder sonogram.
b.The patient should drink 4-6 oz. glasses of water to improve hydration prior to the study.
c.The patient should eat a fatty meal 30 minutes prior to the study.
d.The patient should be fasting for 8-12 hours prior to the study.
e.The patient should be fasting at least 24 hours prior to the study and ingest an anti-gas medication.
The patient should be fasting 8-12 hours prior to the study
You have been requested to perform a gallbladder ultrasound to rule out cholelithiasis. What is cholelithiasis?
a.Gallbladder carcinoma
b.Gallstones
c.Gallbladder polyps
d.Adenomyosis
e. Gallbladder wall thickening
Gallstones
During gallbladder sonography, you notice echogenic foci within the gallbladder but do not detect distal acoustic shadowing. What changes below will improve the detectability of stone shadowing?
a,Increase transducer frequency, focus the beam on the stone
b. Decrease tranducer frequency, increase gain
C.Increase output power, decrease transducer frequency
d.Increase dynamic range, increase gain
e. Focus the beam on the stone, decrease transducer frequency
Increase transducer frequency, focus the beam on the stone
What is the most common cause of acute cholecystitis?
a.Hepatitis
b.Gallstone lodged in the fundus of the gallbladder
c.Calculus obstruction of the gallbladder neck or cystic duct
d.Pancreatitis
e.Hepatocellular carcinoma
Calculus obstruction of the gallbladder neck or cystic duct
Tenderness over the gallbladder with probe pressure is termed:
a.Murphy’s sign
b. Morrison’s pouch
c. Douglas’s sign
d. Tenderness of triez
e. Courvoisier’s gallbladder
Murphys sign
You are performing an abdominal ultrasound study and detect a dilated, non-tender gallbladder and dilated intrahepatic ducts. What should you look for?
aRight kidney hydronephrosis
b. Mass in the head of the pancreas
c. Mass in the posterior right lobe of the liver
d. Abdominal aortic aneurysm
e. Portal vein thrombosis
Mass in the head of the pancreas
Which of the following is a symptom associated with acute cholecystitis?
a.Nausea
b.Vomiting
c.Epigastric pain (pain in middle)
d.Right upper quadrant pain
e. All of the above
All of the above
You have been asked to rule out the presence of choledocholithiasis. What are you looking for?
a. Inflammation with thickening of the gallbladder wall
b.Stones within the common bile duct
c.Calcified gallbladder wall
d.Contracted gallbladder filled with stones
e. Gallbladder carcinoma
Stones within the common bile duct
You are scanning a patient in ICU and notice low-level echoes within the gallbladder consistent with sludge. The gallbladder wall is not thickened. Which statement below is true?
a. The patient most likely has acute acalculas cholecystitis.
b.These findings represent gallbladder perforation.
c. The patient has sludge most likely due to bile stasis.
d. The patient has a porcelain gallbladder.
e. The patient has a pancreatic abnormality.
The patient has sludge most likely due to bile stasis
Ultrasound images obtained on a 48-year-old male show a comet-tail or v- shaped reverberation artifact originating from the anterior wall of the gallbladder. This artifact most likely results from:
a.Adenomyomatosis
b. Gallbladder carcinoma
c. Side lobes
d. Porcelain gallbladder
e. Floating cholesterol stones
Adenomyomatosis
You are performing an ultrasound study to rule out the presence of cholelithiasis.
A small echogenic foci is seen in the posterior aspect of the gallbladder fundus.How can you determine if this foci represents a polyp or a stone?
a.Shadowing is not present with polyps but is present with stones.
b.Unlike a stone, a polyp should move with varying patient positions.
c.A stone will produce a ringdown artifact and a polyp will produce a
d. A polyp is always located in the dependent position.
e.Stones are always larger than polyps.
Shadowing is not present with polyps but is present with stones
What forms the common bile duct?
a.Junction of the cystic duct and common hepatic duct
b.Junction of the right and left hepatic ducts
C.Junction of the common hepatic duct, right and left hepatic ducts
d. Junction of the cystic duct and right hepatic duct e
e.Junction of the duct of Santorini and duct of Wirsung
Junction of the cystic duct and common hepatic duct
You are scanning at the area of the porta hepatis in a patient with alcoholic liver cirrhosis. Two large tubular structures are identified. How can you identify which structures the duct and which is the hepatic artery?
a. The hepatic artery is always located between the portal vein and the bile duct.
b. The bile duct can be compressed with probe pressure and the hepatic artery is not easily compressed.
C.The bile duct will dilate with a Valsalva maneuver and the hepatic artery will not dilate.
d. Doppler signals can be elicited from the artery but not the bile duct.
e. All of the above
Doppler signals can be elicited from the artery but not the bile duct
A patient is referred for an abdominal ultrasound. You notice a yellow discoloration of the eyes and skin. This condition is called:
a. Hypoalbuminemia
b. Biliary stasis
c. Erythema
d.Pruritus
e.Jaundice
Jaundice
The thin capsule surrounding the liver is known as:
a.Reidel’s capsule
b.Glisson’s capsule
c. Teres capsule
d. Langerhans’ capsule
e. Wirsung’s capsule
Glissons capsule
A patient is referred for a liver ultrasound with the clinical history of a raised serum alpha-fetoprotein level. What should you look for?
a.Focal nodular hyperplasia
b Fatty liver
c. Hepatocellular carcinoma
d.Hydatid disease
e.Increased alph-fetoprotein levels are not associated with liver disease
Heptocellular carcinoma
You see a hepatic mass on a young female who is taking birth control pills. The mass has a surrounding halo. You should suspect:
a. Hydatid disease
b.Focal nodular hyperplasia
c. Hepatic adenoma
d. Metastatic disease
e.Fatty liver
Hepatic Adenoma
Sheep and cattle.
a.Hepatocellular carcinoma
b.Hydatid disease
c.Focal nodular hyperplasia
d.fatty liver
e. Cavernous hemangioma
Hydatid disease
Mass with a central scar.
a. Hydatid disease
b. Cavernous hemangioma
c. Hepatorcellular carcinom
d. Fatty liver disease
e. Focal nodular hyperplasia
Focal modular hyperplasia
