URR 30 Flashcards
1
Q
Vessels that touch or are occluded by tumor are categorized according to a _____
A
pancreatic color Doppler score
2
Q
If too many vessels in the pancreas are affected by a pancreatic cancer tumor, ____ may not be a treatment option
A
resection
3
Q
most common primary malignancy of pancreas
A
adenocarcinoma
4
Q
90% of pancreatic adenocarcinomas originate from the ____
A
ductal system
5
Q
Most common malignant cause of biliary ductal obstruction
A
pancreatic adenocarcinoma
6
Q
70% of pancreatic adenocarcinoma tumors are locateed:
A
in the head of the pancreas
7
Q
Risk factors for pancreatic adenocarcinoma
A
high fat diet
smoking
chronic pancreatitis
sclerosing cholangitis
family history
diabetes
8
Q
Clinical symptoms of pancreatic adenocarcinoma
A
pain
weight loss
nausea
vomiting
malaise
9
Q
____ and ____ are common clinical findings of pancreatic adenocarcinoma
A
palpable gallbladder
obstructive jaundice
10
Q
Most patients demonstrate ____ pancreatic enzyme levels with pancreatic adenocarcinoma
A
normal
11
Q
Pancreatic adenocarcinoma usually presents in the ___ decade of life
A
5th
12
Q
The majority of patients with pancreatic adenocarcinoma demonstrate ____ and ____
A
liver metastases
lymphadenopathy
13
Q
Most lethal malignancy of all types of cancer
A
pancreatic adenocarcinoma
14
Q
Sonographic appearance of pancreatic adenocarcinomas
A
solid, hypoechoic lobulated mass, usually in head; irregular borders
15
Q
Indirect signs of pancreatic adenocarcinoma
A
dilated biliary tree and pancreatic duct
Courvoisier gallbladder
Ascites
High incidence of ductal obstruction
can demonstrate a pseudocyst
16
Q
slow growing malignancy within pancreas; rare
A
mucinous cystadenocarcinoma
17
Q
Clinical symptoms of mucinous cystadenocarcinoma
A
abdominal mass
jaundice
weight loss
Courvoiser sign
18
Q
Lab testing associated with mucinous cystadenocarcinoma
A
increased amylase, bilirubin, alkaline phosphatase; Increased CEA tumor marker
19
Q
Sonographic appearance of mucinous cystadenocarcinomas
A
cystic mass with septations and mural nodules
thick irregular walls
20
Q
Pancreatic adenocarcinoma tumors are most commonly foundin __ and ____ of the pancreas
A
body
tail
21
Q
Metastases to the pancreas is __X more common than primary pancreatic cancer
A
4
22
Q
Most common primaries to metastasize to the pancreas
A
renal cell carcinoma
lung
breast
melanoma
colon
stomach
23
Q
A Whipple procedure is also known as:
A
pancreaticoduodenectomy
24
Q
most commonly performed operation to treat pancreatic cancer
A
Whipple procedure
25
removal of the head, and sometimes the body of the pancreas, the duodenum and the gallbladder, part of the jejunum, stomach, bile duct, and lymph nodes near the pancreas
Whipple procedure
26
The bile duct is attached to a remaining segment of the ____ in a Whipple procedure
small intestine
27
Contraindications to the Whipple procedure
tumors larger than 2 cm
extracapsular extension
vascular invasion
lymphadenopathy
metastatic disease
28
Complications of the Whipple Procedure
infections
bleeding
leaking of pancreatic enzymes
difficulty emptying the stomach after consumption
inflammation of the pancreas, pseudocyst
29
most common reason for pancreas transplant
insulin dependent diabetic with renal failure
30
A pancreatic transplant is most commonly performed with a ____ transplant
renal
31
most common cause of a pancreas transplant ALONG with a renal transplant
Uncontrolled Type I diabetes
32
Diabetes causes ____ and ____ that can be treated with double organ tranplant
renal failure
insulin dependency
33
most common location for pancreas allograft
right iliac fossa
34
Exocrine drainage from the pancreas is usually sent into the ____ or _____
small intestine
urinary bladder
35
____ levels can determine the endocrine function of a pancreatic transplant
Blood glocuse
36
__, ___, and ___ levels can evaluate the exocrine function of a pancreatic allograft
amylase
lypase
anodal trypsinogen
37
__ and __ function of the pancreas should be demonstrated by increasing levels after surgery that should normalize with normal function
exocrine
endocrine
38
The ____ space should be evaluated for fluid collection
peritransplant
39
Images of the peritransplant space around the pancreas should be evaluated for ____
fluid collection
40
Images of the bowel should be taken during a pancreatic transplant exam to look for:
obstruction with enteric exocrine drainage
41
Images of the urinary bladder during a pancreatic transplant to visualize the ______ with bladder drainage
urinary bladder
42
Color Doppler evaluation of renal transplant
Y-Graft from the recipient arterial anastamosis, across both limbs of Y-graft to both the superior mesenteric artery and splenic arterial anastamosis
43
Spectral Doppler evaluation of renal transplant
with the recipient artery proximal to the Y-graft anastamosis and within the Y-graft itself, splenic artery, and superior mesenteric artery
44
The ___ and __ should be measured during a pancreatic transplant evaluation
PSV
RI
45
Color and Spectral Doppler images pancreas transplant evaluation
graft splenic vein
superior mesenteric vein
portal vein to recipient venous anastomosis
46
Acute rejection of pancreas leads to ______ flow in transplant arteries and _____ appearance of the gland
high resistance
heterogeneous
47
Complications of renal transplant
pancreatitis
arterial or venous thrombosis
fluid collections
48
most common cause of ductal dilatation
stone formation in pancreatic duct or at the Ampulla of Vater
49
most common congenital pancreatic anomaly
pancreas divisum
50
most common complication of cystic fibrosis
meconium ileus
51
most common cause of acute pancreatitis
biliary tract disease
52
second most common cause of acute pancreatitis
alcohol abuse
53
most common vessel thrombosed with acute pancreatitis
splenic vein
54
Pseudocyst formation is most commonly found within:
the lesser peritoneal sac (omental bursa)
55
Pseudocysts are much more common than ___ cysts
true
56
most common type of lesion in Von Hippel Lindau Syndrome
pancreatic cysts
57
most common benign tumor of the pancreas
islet cell tumors
58
Islet cell tumors most commonly form in ___ and ___ of the pancreas
body
tail
59
most common islet cell tumor
insulinomas
60
Benign neoplasms usually form in the ___ and ___ of the pancreas
body
tail
61
Malignant neoplasms usually form in the ____ of the pancreas
head
62
most common primary malignancy of pancreas
adenocarcinoma
63
most common malignant cause of biliary ductal obstruction
adenocarcinoma
64
Metastasis to the pancreas is __X more common than primary pancreatic cancer
4
65
Most common primaries to metastasize to the pancreas
renal cell carcinoma
lung
breast
melanoma
colon
stomach
66
most commonly performed operation to treat pancreatic cancer
Whipple procedure
67
most common location for allograft
right iliac fossa
68
most common reason for pancreas transplant
insulin dependent diabetic with renal failure
69
a pancreas transplant is most commonly performed with a ____
renal transplant
70
most common cause of a pancreas transplant ALONG WITH a renal transplant
Type I Diabetes
71
All of the following are associated with pancreatic cyst formation, except?
a. Autosomal Dominant Polycystic Disease
b. Von Hippel Lindau Syndrome
c. Pancreatitis
d. multiple endocrine neoplasm syndrome
d
72
What is the most common pancreatic lesion seen with Von Hippel Lindau Syndrome?
a. adenocarcinoma
b. simple cysts
c. pseudocysts
d. pancreatitis
b
73
What differentiates a simple cyst from a pseudocyst?
a. presence of an epithelial lining
b. size
c. shape
d. all the above
a
74
Pseudocyst formation is most commonly seen with:
a. gastrinoma formation
b. insulinoma formation
c. acute pancreatitis
d. chronic pancreatitis
c
75
What clinical indication is seen with insulinomas?
a. malignant HTN
b. hypoglycemia
c. hyperglycemia
d. hypercalcemia
b
76
Gastrinomas are associated with which of the following?
a. Peptic ulcer
b. MEN syndrome
c. Zollinger Ellison Syndrome
d. all the above
d
77
Tumors that secrete gastrin are associated with which of the following?
a. Zollinger-Ellison syndrome
b. pancreatitis
c. mucinous cystadenocarcinoma
d. serous cystadenocarcinoma
a
78
Most benign tumors of the pancreas:
a. are isoechoic to the gland
b. form in the body/tail of the gland
c. are not visible on ultrasound
d. cause diabetes
b
79
The malignant form of macrocystic cystadenoma is:
a. cystadenocarcinoma
b. lymphoma
c. leukemia
d. sarcoma
a
80
Tumors of the pancreatic head:
a. are usually malignant
b. are usually identified early than tumors of the tail
c. must be evaluated for extension into adjacent vasculature
d. all the above
d
81
Which of the following are symptoms of adenocarcinoma of the pancreas?
a. palpable gallbladder
b. obstructive jaundice
c. normal pancreatic enzyme levels with elevated bilirubin
d. all the above
d
82
What is an indirect sign of pancreatic cancer?
a. double duct sign
b. solid mass in the head
c. hypoechoic mass in the head
d. lobulated mass in the head
a
83
Which of the following is a contraindication for the Whipple procedure?
a. tumor in the pancreatic head
b. tumoral invasion of multiple blood vessels
c. choledocholithiasis
d. tumor larger than 1 cm
b
84
The most common reason for a pancreas transplant is ____.
a. mucinous cystadenocarcinoma
b. metastatic tumor formation
c. uncontrolled type I disease
d. Von Hipple Lindau Syndrome
c
85
Pancreatic transplant rejection is demonstrated by:
a. increasing insulin levels after surgery
b. high resistance flow in pancreatic arteries
c. increasing amylase levels after surgery
d. all the above
b
86
Which of the following describes the sonographic appearance of focal nodular hyperplasia?
a. single or multiple hypoechoic, rounded masses with mild posterior shadowing within the liver parenchyma
b. diffuse echogenic nodules or foci scattered throughout liver parenchyma
c. a single mass <5cm with a central scar and prominent central and radial vascularity
d. a single hyperechoic mass most commonly found adjacent to the porta hepatis
c
87
Which metabolic infiltrative disorder is associated with hepatic adenoma formation?
a. hemochromatosis
b. Wilson disease
c. amyloidosis
d. Von Gierke disease
d
88
Which of the following is true regarding a liver hemangioma?
a. most hemangiomas demonstrate some level of posterior shadowing
b. A hemangioma is composed of an abnormal concentration of smooth muscle and Kupffer cells within the liver
c. Fluid and debris levels are commonly present in a hemangioma
d. Color Doppler is not usually helpful in evaluating this highly vascular mass
d
89
A 10 year old presents for an abdominal ultrasound with a palpable RUQ mass. He has no history of liver disease and alpha-fetoprotein levels are normal. You identify a 9 cm mass in the right lobe that demonstrates punctate calcifications and a central scar. These findings are most suggestive of?
a. fibrolamellar carcinoma
b. metastasis
c. hepatoma
d. hepatoblastoma
a
90
What fetal syndrome is most commonly associated with hepatoblastoma?
a. Budd Chiari Syndrome
b. Beckwith- Wiedemann Syndrome
c. Trisomy 13
d. Down Syndrome
b
91
What is the most common liver malignancy identified on ultrasound?
a. adenoma
b. Klatskin tumor
c. metastatic tumor
d. hepatoma
c
92
If tardus parvus waveforms are identified in the intrahepatic artery waveforms of a transplant, this finding is ____. If biphasic waveforms are identified in the right and left hepatic arteries, the finding is ____.
a. suspicious for organ rejection, suspicious for hepatic artery stenosis
b. normal, suspicious for hepatic artery stenosis
c. suspicious for hepatic artery stenosis, normal
d. suspicious for hepatic artery stenosis, suspicious for organ rejection
d
93
the most common benign liver tumor is:
a. Klatskin tumor
b. hepatitis
c. polycystic liver disease
d. cavernous hemangioma
d
94
What is the most common cause of a hepatic abscess in the US?
a. osteomyelitis and endocarditis
b. E. coli from digestive tract
c. appendicitis and diverticulitis
d. cholangitis and cholecystitis
d
95
High-intensity transient signals (HITS) are seen on the Doppler evaluation of a patient with:
a. hyperfunctioning adenoma
b. portal venous gas
c. critical renal artery stenosis
d. significant aortic stenosis
b
96
A liver mass with a hypoechoic rim should create a strong suspicion of:
a. malignancy
b. hepatic lipoma
c. liver adenoma
d. portal hypertension
a
97
What usually causes an echinococcal cyst in the liver?
a. ingestion of raw pork
b. ingestion of raw oysters
c. hemangioma
d. hepatitis
a
98
____ is the most common malignant liver mass found in children.
a. mets from nephroblastoma
b. mets from brain
c. hepatoma
d. hepatoblastoma
d
99
Which liver disorder leads to the sonographic appearance of hepatomegaly with decreased echogenicity and scattered bright portal reflections within the parenchyma?
a. hydatid disease
b. chronic viral hepatitis
c. cirrhosis
d. acute viral hepatitis
d
100
About 50% of all primary tumors that metastasize to the liver are drained through the:
a. IVC
b. Aorta
c. hepatic vein
d. portal vein
d
