URR 31 Flashcards
1
Q
Which of the following findings will indicate hepatomegaly is present?
a. when the right lobe is rounded inferiorly and extends below the lower pole of the right kidney, the liver is considered enlarged.
b. when the right lobe is rounded inferiorly and extends past the upper pole of the right kidney, the liver is considered enlarged
c. the liver is considered enlarged when the AP measurement exceeds 15.5 cm
d. Hepatomegaly causes rounding of the superior liver segments
A
a
2
Q
Which of the following is not an expected finding with fatty infiltration of the liver?
a. cystic degeneration
b. brighter parenchymal echoes
c. increased attenuation
d. degraded visualization of vessels
A
a
3
Q
Which of the following statements is true regarding the sonographic appearance of fatty infiltration?
a. as fatty infiltration increases in the liver, the hepatic vein branches becomes increasingly visible
b. as fatty infiltration increases in the liver, the portal vein branches become more difficult to visualize
c. as fatty infiltration increases in the liver, all walls of liver vascularity become increasingly echogenic
d. as fatty infiltration increases in the liver, the walls of the portal vein branches become increasingly echogenic
A
b
4
Q
While scanning the liver in a patient with chronic cirrhosis, you notice a tubular vessel connecting to the splenic vein just prior to its confluence with the SMV. Flow within the vessel is very low velocity, continuous and moving in a cephalic direction. Which of the following explains the ultrasound findings?
a. a dilated umbilical vein is present which is a common complication of cirrhosis
b. a dilated SMV is present with flow reversal which is a common complication of cirrhosis
c. a dilated coronary vein is present which is a common complication of cirrhosis
d. the ductus venosus is dilated with antegrade flow which is a common complication of cirrhosis
A
c
5
Q
Diastolic flow reversal in the right and left hepatic arteries of a newly placed liver allograft indicates:
a. portal hypertension is present
b. possible rejection
c. significant stenosis of the common hepatic artery
d. normal surgical post-findings
A
b
6
Q
____ is the most common cause for micronodular cirrhosis and ______ is the most common cause of macronodular cirrhosis.
a. alcohol consumption, chronic viral hepatitis
b. alcohol consumption, analgesic consumption
c. analgesic consumption, alcohol consumption
d. chronic viral hepatitis, alcohol consumption
A
a
7
Q
Liver transplant evaluation requires PW Doppler evaluation of all of the following, except:
a. IVC anastamosis
b. biliary anastamosis
c. portal anastamosis
d. hepatic arterial anastamosis
A
b
8
Q
Schistosomiasis is an ____ cause of portal hypertension. Budd-Chiari is an ____ cause of portal hypertension.
a. intrahepatic presinusoidal, extrahepatic postsinusoidal
b. intrahepatic presinusoidal, extrahepatic presinusoidal
c. intrahepatic presinusoidal, intrahepatic postsinusoidal
d. extrahepatic presinusoidal, intrahepatic postsinusoidal
A
c
9
Q
A vascular condition of the liver seen in women who take oral contraceptives is:
a. Budd Chiari syndrome
b. portal venous gas
c. Hereditary telangiectasia
d. portal aneurysm
A
a
10
Q
In a patient with cirrhosis, the ____ lobe of the liver can enlarge to nearly half the size of the right lobe.
a. left
b. caudate
c. quadrate
d. none of the above, the entire liver shrinks in size with cirrhosis
A
b
11
Q
A patient presents with abdominal pain for 3 months following a missionary trip to India. Lab values demonstrate normal LFTs. The US exam demonstrates a 3cm cyst with septations in the right lobe of the liver. These findings are most consistent with:
a. histoplasmosis infection
b. hydatid disease
c. candidiasis
d. schistosomiasis
A
b
12
Q
The most common cause of spread of hepatitis in the US is:
a. blood transfusions
b. liver transplants
c. hereditary infection
d. IV drug users
A
d
13
Q
A patient presents with lower extremity edema and increased abdominal girth 2 weeks after a liver transplant. These findings are most suggestive of what complication?
a. hepatic artery stenosis
b. biliary stricture
c. hepatic vein stenosis
d. cholangitis
A
c
14
Q
____ is the most common malignancy of the liver seen in a patient with AIDS. ____ is the most common infection of the liver seen in a patient with AIDS.
a. hepatocellular carcinoma, hepatitis
b. hepatoblastoma, candidiasis
c. Kaposi Sarcoma, pneumocystis carinii
d. metastasis, schistosomiasis
A
c
15
Q
Triglyceride accumulation in the liver leads to ____, while copper accumulation in the liver leads to ____.
a. amyloidosis, hemochromatosis
b. amyloidosis, steatosis
c. steatosis, Wilson disease
d. steatosis, hemochromatosis
A
c
16
Q
A patient presents for a follow up ultrasound due to Budd Chiari Syndrome. Which of the following is an expected finding on the exam?
a. pancreatic head mass and dilated intrahepatic ducts
b. prostatitis and neurogenic bladder
c. thrombosis of the hepatic veins with hepatic congestion
d. adrenal adenoma and/or kidney adenoma
A
c
17
Q
What condition is associated with prominent portal walls?
a. acute viral hepatitis
b. cirrhosis
c. fatty infiltration
d. hemangioma
A
a
18
Q
Portal thrombosis may lead to an accumulation of fluid in the abdomen called:
a. retroperitoneal effusion
b. pleural effusion
c. ascites
d. pericardial effusion
A
c
19
Q
The Ultrasound Liver Imaging Reporting and Data System is used to assess patients at risk for:
a. liver metastasis
b. cirrhosis
c. lymphoma
d. hepatocellular carcinoma
A
d
20
Q
What is a potentially life threatening complication of portal HTN?
a. ascites formation
b. ruptured gastroesophageal varices
c. pulmonary embolism
d. aortic embolism
A
b
21
Q
Which of the following describes the most common sonographic appearance of a hepatoma?
a. solid mass that may be more or less echogenic than liver parenchyma
b. usually causes multiple diffuse solid mass formation
c. most commonly demonstrates diffuse coarse liver texture in the affected lobe
d. echogenic mass with a central scar
A
a
22
Q
Hypoalbuminemia associated with cirrhosis leads to:
a. hepatomegaly
b. nodule formation
c. liver capsule contraction and surface irregularities
d. gallbladder and bowel wall thickening
A
d
23
Q
Liver elastography is used for:
a. staging of steatosis
b. staging of primary malignancy
c. staging of secondary malignancy
d. staging of fibrosis
A
d
24
Q
The US exam of a patient’s liver demonstrates a patent umbilical vein. The most common cause for this recanalization is:
a. ascites
b. hepatitis
c. portal HTN
d. abscess
A
c
25
Which of the following correctly describes how contrast enhanced ultrasound can be used to differentiate benign and malignant masses?
a. significant contrast uptake occurs in malignant nodules, while no contrast uptake is seen in benign nodules
b. benign nodules usually demonstrates isovascular enhancement while malignant tumors usually demonstrate hypervascular enhancement
c. significant contrast uptake occurs in benign nodules, while no contrast uptake is seen in malignant nodules
d. benign nodules usually demonstrate hypervascular enhancement while malignant tumors usually demonstrate hypovascular enhancement
b
26
Which of the following correctly describes how to determine if a peripheral mass is intrahepatic or extrahepatic?
a. evaluate the biliary tree for the presence of dilatation which is only seen with an extrahepatic mass
b. use PW Doppler to obtain the resistive index of the lesion and compare it to the resistive index of the normal liver tissue
c. assess the location of the mass in relation to the stomach
d. assess the liver capsule and look for indentations that indicate extrahepatic origin or outward bulging that indicates intrahepatic origin
d
27
If a patient presents with a history of right breast cancer and you identify a solid liver mass with a hypoechoic halo, what is the most likely diagnosis of this finding?
a. hepatic metastasis
b. hepatocellular carcinoma
c. hepatic adenoma
d. focal nodular hyperplasia
a
28
Which of the following describes the appearance of the liver in a patient in the later stages of cirrhosis caused by viral hepatitis?
a. significant hepatomegaly with diffuse decrease in hepatic echotexture
b. multiple nodules usually 1-5 cm in size
c. multiple nodules usually <1cm in size
d. diffuse coarse liver echotexture with no nodule formation
b
29
Steatosis refers to:
a. glycogen storage disease of the liver
b. chronic hepatitis infection
c. fatty liver disease
d. pneumocystis carinii
c
30
How can a hepatic adenoma be differentiated from focal nodular hyperplasia on contrast ultrasound?
a. FNH lesions demonstrate significant contrast uptake while adenomas demonstrate no contrast uptake
b. FNH lesions demonstrates no contrast uptake while adenomas demonstrate significant contrast uptake
c. FNH lesions usually demonstrate centrifugal enhancement while adenomas demonstrate centripetal enhancement
d. FNH lesions usually demonstrate centripetal enhancement while adenomas demonstrate centrifugal enhancement
c
31
Which of the following is most likely to demonstrate a simply cyst with gravity dependent debris in the right lobe of the liver?
a. early echinococcal infection
b. chronic hydatid infection
c. chronic focal nodular hyperplasia
d. early schistosomiasis infection
a
32
The most common finding with congestive hepatomegaly is:
a. liver atrophy
b. IVC dilatation
c. portal vein aneurysm
d. aortic aneurysm
b
33
Which of the following findings indicates a failed transjugular intrahepatic shunt?
a. continuous flow pattern within the shunt
b. diminished flow in the right and left portal branches
c. spleen length <12cm in average patient
d. hepatofugal flow in the main portal vein
d
34
A portal vein diameter that is greater than or equal to ___ indicates portal HTN.
a. 8mm
b. 10mm
c. 13mm
d. 15mm
c
35
A 75 year old female presents with RUQ pain. She was diagnosed with cirrhosis 4 years ago. Lab values demonstrate increased levels of alpha fetoprotein, ALP, AST, and ALT. The US exam demonstrates a heterogeneous liver texture that is decreased in size. The left lobe contains a new round hypoechoic mass with increased vascularity. These findings are most suggestive of:
a. hydatid cyst
b. focal nodular hyperplasia
c. metastatic lesion
d. hepatocellular carcinoma
d
36
A patient is scheduled for abdominal ultrasound every 6 months due to their history of cirrhosis. What is the primary reason for serial exams?
a. increased risk of tumor invasion of the portal vein from metastatic lesions
b. evaluate for pleural effusion
c. evaluate for the development of an abscess
d. increased risk of portal thrombosis
d
37
Portalization of the hepatic veins is a common finding in which of the following?
a. severe tricuspid regurgitation
b. mild to moderate steatosis
c. advanced cirrhosis
d. hemolytic anemia
c
38
Which of the following liver tumors is usually treated by surgical resection due to risk of hemorrhage and malignant transformation?
a. hemangioma
b. adenoma
c. pyogenic abscess
d. lipoma
b
39
Hepatic artery hypertrophy is a common finding with:
a. celiac axis stenosis
b. cirrhosis
c. cholecystitis
d. splenic vein thrombosis
b
40
Reye syndrome will demonstrate features on the liver ultrasound that are similar to:
a. steatosis
b. metastasis
c. advanced cirrhosis
d. autosomal dominant polycystic disease
a
41
A patient presents with new onset of jaundice 2 weeks after a liver transplant. This clinical finding is most suggestive of what complication?
a. portal vein stenosis
b. biliary stricture
c. hepatic vein stenosis
d. hepatic artery stenosis
b
42
A patient presents with a history of hepatitis C and you identify a solid liver mass with a hypoechoic halo. This finding is most consistent with:
a. hepatocellular carcinoma
b. hepatic adenoma
c. focal nodular hyperplasia
d. hepatic metastasis
a
43
Contrast enhanced ultrasound is used to determine the outcome of tumor ablation in the liver. If the procedure was a success, what are the expecting findings on the image?
a. contrast uptake occurs during venous phase
b. consistent contrast uptake occurs during the arterial and venous phase
c. contract uptake occurs during the arterial phase
d. No contrast enters the lesion during the cardiac cycle
d
44
A patient is referred for an abdominal ultrasound after a CT demonstrated a possible mass near the fundus of the gallbladder. The ultrasound demonstrates mild hepatomegaly with a mild diffuse increase in echogenicity. The area in question appears hypoechoic to the surrounding tissues. These findings are most suggestive of:
a. hepatic adenoma
b. focal fatty sparing
c. diffuse fatty infiltration
d. cystic artery thrombosis
b
45
A mass that presents with a bulls eye appearance within the liver tissue is most likely ____
a. lymphoma
b. metastasis
c. fatty sparing
d. focal nodular hyperplasia
b
46
A ____ abscess is caused by bacteria and most commonly forms within the right lobe of the liver. A ____ abscess is caused by a parasite and usually forms in the right dome of the liver causing elevation of the diaphragm.
a. fungal, pyogenic
b. pyogenic, amebic
c. parasitic, fungal
d. amebic, pyogenic
b
47
Which of the following is commonly associated with contaminated water and causes debris/occlusion within intrahepatic portal venous system?
a. amebic abscess
b. pyogenic abscess
c. candidiasis
d. schistosomiasis
d
48
Which of the following is a potential collateral pathway formed in patients with cirrhosis?
a. blood moves from the gastric vein into the splenic vein
b. blood moves from the emissary veins into the umbilical vein
c. blood moves from the coronary and short gastric veins into the esophageal veins
d. blood moves from the splenic vein into the coronary vein
c
49
In patients with cirrhosis, what effect will deep inspiration have on the portal vein?
a. the portal vein diameter will increase by 50%
b. the portal vein diameter will double in size
c. there will be minimal change in the portal vein diameter
d. the portal vein will collapse at the point of deepest inspiration
c
50
___ usually presents as multiple target lesions in the liver.
a. Klatskin tumor
b. metastasis
c. fungal abscess
d. hydatid disease
b
51
A patient presents with splenomegaly and multiple, small, tortuous vessels are visualized in the porta hepatis area of the liver. These vessels most likely represent:
a. dilated extrahepatic biliary system
b. cavernous transformation
c. duplicated hepatic artery
d. portal aneurysm
b
52
Shear wave elastography can be used to assess the liver. Which of the following correctly describes the results of an abnormal exam?
a. blue color superimposed over liver parenchyma indicates liver fibrosis
b. lower values indicate liver fibrosis
c. red color superimposed over liver parenchyma indicates liver fibrosis
d. higher values indicate liver fibrosis
d
53
54
Which type of liver abscess presents as a mass with the appearance described as a wheel within a wheel?
a. viral
b. pyogenic
c. fungal
d. amebic
c
55
While performing ultrasound on the liver, a transverse view reveals a hyperechoic triangular structure in the inferior left lobe. The hyperechoic structure demonstrates an anechoic center that fills with color when Doppler is applied. Which of the following best describes the finding identified on the image?
a. recanalized umbilical vein
b. focal nodular hyperplasia
c. metastasis
d. recanalized coronary vein
a
56
A liver ultrasound demonstrates a hyperechoic mass with smooth borders and posterior enhancement in the posterior right lobe. These findings are most suggestive of:
a. cavernous hemangioma
b. hepatic adenoma
c. hepatocellular carcinoma
d. focal fatty sparing
a
57
___ should be suspected in an infant with a large hepatic hemangioma and unexplained thrombocytopenia.
a. cirrhosis
b. Budd Chiari Syndrome
c. Kasabach-Merritt Syndrome
d. Fragile X syndrome
c
58
Which of the following sonographic characteristics is associated with Budd Chiari Syndrome?
a. dilated IVC
b. portal system aneurysm
c. agenesis of the hepatic artery
d. atrophied hepatic veins
d
59
60
The primary finding that differentiates liver mass formation from steatosis is:
a. steatosis will demonstrate normal vessel course through affected areas, while mass formation displaces vasculature
b. steatosis will caused dilated hepatic veins, while mass formation will cause narrowed hepatic veins
c. steatosis will cause wall thickening of the portal system, while mass formation invades the wall
d. steatosis causes an irregular liver surface contour, while mass formation does not effect the surface contour of the liver
a
61
Which of the following Doppler characteristics of the hepatic arteries will be seen in a normal liver transplant?
a. increased resistive index
b. diastolic flow reversal
c. sharp systolic upstroke
d. prolonged acceleration time
c
62
The most frequent involved organ in metastatic disease is the:
a. pancreas
b. spleen
c. liver
d. GI tract
c
63
Benign liver masses will usually demonstrate ultrasound contrast enhancement during the arterial and portal venous phases of imaging. Malignant masses will usually demonstrate:
a. contrast enhancement during the arterial and portal venous phases of imaging
b. no contrast enhancement
c. contrast enhancement during the arterial phase of imaging
d. contrast enhancement during portal venous phase of imagin
c
64
Periportal cuffing is a sign of:
a. acute viral hepatitis
b. Caroli disease
c. intrahepatic biliary tree obstruction
d. extrahepatic biliary tree obstruction
a
65
Fulminant hepatitis is most commonly caused by:
a. alcohol abuse
b. fungal infection
c. acetaminophen abuse
d. viral infection
c
66
When reviewing a prior US exam for the same patient, you come across an image labeled "sandwich sign". What are they referring to?
a. the head of the pancreas is abnormally compressed between the liver and great vessels
b. lymphadenopathy surrounding the portal vein
c. extrinsic compression of the IVC by a pancreatic tumor
d. the layering of the stomach wall at the head of the pancreas
b
67
____ abscesses are most commonly found in countries outside the US. ____ abscesses are most commonly seen in immunosuppressed patients.
a. fungal, pyogenic
b. amebic, fungal
c. pyogenic, amebic
d. fungal, amebic
b
68
____ is the most common liver malignancy, while ___ is the most common primary liver malignancy.
a. hepatocellular carcinoma, fibrolamellar carcinoma
b. metastasis, hepatocellular carcinoma
c. hepatocellular carcinoma, Kaposi sarcoma
d. hepatocellular carcinoma, metastasis
b
69
Which of the following describes the Doppler appearance of a liver transplant rejection?
a. high resistance flow in the hepatic artery
b. mottled appearance of the liver parenchyma with ascites
c. low resistance flow in the portal vein
d. nodular formations within the liver parenchyma
a
70
Reduced glycogen storage in the liver usually causes the liver parenchyma to have a sonographic appearance similar to:
a. steatosis
b. polycystic disease
c. cirrhosis
d. acute viral hepatitis
d
71
Which of the following serum levels would be unaffected by a benign obstruction of the biliary tree?
a. alpha feto-protein
b. alkaline phosphatase
c. conjugated bilirubin
d. gamma glutamyl transpeptidase
a
72
What is the proper patient position and respiration for assessing the portal vein diameter?
a. supine with quiet respiration
b. right lateral decubitus position with deep inspiration
c. left lateral decubitus with deep inspiration
d. supine with inspiration and Valsalva strain
a
73
Which of the following will cause an increase in alpa fetoprotein values in pediatric patients?
a. focal nodular hyperplasia
b. polycystic liver disease
c. glycogen storage disease
d. hepatoblastoma
d
74
Increased serum levels of ____ usually provide the first indication of an extrahepatic biliary obstruction
a. indirect bilirubin
b. alkaline phosphatase
c. aldosterone
d. direct bilirubin
b
75
Which of the following organs should be evaluated when looking for a tumor of the endocrine system?
a. pancreas and kidneys
b. salivary glands and adrenal glands
c. liver, spleen, and pancreas
d. pancreas and adrenal glands
d
76
Which of the following pancreatic abnormalities are most associated with an increase in amylase and lipase levels in the blood?
a. acute pancreatitis and pseudocyst
b. pseudocyst and adenoma
c. chronic pancreatitis and pseudocyst
d. pseudocyst, acute pancreatitis, and chronic pancreatitis
a
77
Which of the following pancreatic abnormalities will cause an increase in insulin levels in the blood?
a. pseudocyst
b. acute pancreatitis
c. islet cell tumor
d. chronic pancreatitis
c
78
Which of the following describes the best technique to differentiate a polyp in the gallbladder wall from a stone within the lumen?
a. apply color doppler
b. ask the patient to perform the valsalva maneuver
c. have the patient drink water and rescan the gb
d. roll the patient into LLD position
d
79
Several simple cysts are identified in the liver of a 38 year old male patient. What structures in the abdomen should also be evaluated for related findings?
a. abdominal aorta and renal arteries
b. kidneys, pancreas, and ovaries
c. kidneys and pancreas
d. kidneys and thyroid
c
80
What liver mass is associated with glycogen storage disease?
a. adenoma
b. hepatoma
c. lipoma
d. hamartoma
a
81
A patient presents for an abdominal sonogram due to a history of esophageal varices. What structure(s) should be closely evaluated for related findings?
a. splenic artery
b. portal system
c. pylorus
d. renal arteries
b
82
Which of the following liver disorders will result in increased levels of iron stored in the liver?
a. Wilson disease
b. hemochromatosis
c. glycogen storage disease
d. amyloid disease
b
83
Which of the following is a reason for a patient to be NPO prior to an abdominal ultrasound?
a. dilate the venous system for easier visualization
b. dilate the biliary tree for easier visualization
c. decrease blood sugar for better pancreas visualization
d. decrease gas and peristalsis in GI tract
d
84
The administration of aspirin to a child with chicken pox can lead to what deadly disorder that affects the liver and brain?
a. Trisomy 21
b. cirrhosis
c. autosomal dominant polycystic disease
d. Reye syndrome
d
85
A 60 year old male presents for an abdominal ultrasound for recurrent epigastric pain. The patients tells you this is the fourth time he has been hospitalized for pancreatitis and the medications are just not working. What is the expected appearance of his pancreas on ultrasound?
a. atrophied with calcifications in the parenchyma
b. increased size with decreased echogenicity
c. atrophied with multiple cysts and hypervascularity of the parenchyma
d. enlarged and edematous with a hyperechoic appearance
a
86
Which liver function level is the most sensitive indicator for alcoholism?
a. AST
b. ALT
c. AFP
d. GGTP
d
87
Steatorrhea is a clinical finding with:
a. splenic or hepatic hamartomas
b. aortic or splenic aneurysms
c. hyperparathyroidism or parathyroid adenoma
d. pancreatitis or celiac disease
d
88
A patient presents for an abdominal US to verify findings identified on a CT exam. The CT report indicates numerous cystic structures throughout the liver that do not communicate with the biliary tree or the vascular system. Which of the following best describes the expected US findings?
a. Caroli Disease
b. polycystic disease
c. Budd Chiari malformation
d. choledochal cysts
b
89
A patient presents for an abdominal ultrasound due to loss of appetite, weight loss, and epigastric pain. A hypoechoic mass is identified in the anterior aspect of the head of the pancreas. Which of the following best describes the next step in evaluating this patient?
a. evaluating the surrounding areas for lymphadenopathy
b. apply color Doppler to the area to determine if the hypoechoic area is a possible portal thrombosis
c. review the patient chart to view the pancreatic enzyme levels related to acute pancreatitis
d. evaluate the gallbladder for stones
a
90
Which of the following lab values will increase with mucinous cystadenocarcinoma of the pancreas?
a. Alanine aminotransferase
b. hematocrit
c. carcinoembryonic antigen
d. alkaline phosphatase
c
91
a patient presents for an abdominal US exam with a history of a recent single episode of significant indigestion. The lab results demonstrate increased levels of AST and normal levels of ALT, alkaline phosphatase, and bilirubin. These clinical findings are most consistent with:
a. chronic hepatitis C
b. biliary stasis with a partial ductal obstruction due to Klatskin tumor
c. schistosomiasis
d. myocardial infarction
d
92
Which of the following liver abnormalities can be related to the use of oral contraceptives?
a. liver metastasis and hepatic adenoma
b. hydatid disease and schistosomiasis
c. Budd Chiari Syndrome and hydatid disease
d. hepatic adenoma and Budd Chiari Syndrome
d
93
Which of the following is an expected clinical symptom of an abscess?
a. polycythemia vera
b. malignant HTN
c. anemia
d. leukocytosis
d
94
Dark urine and pale stool are indications of:
a. diverticulitis
b. ulcerative colitis
c. renal cell carcinoma
d. hyperbilirubinemia
d
95
Which of the following will typically demonstrate normal values on liver function tests?
a. fatty liver
b. hepatocellular carcinoma
c. adenoma
d. hepatoblastoma
c
96
A patient presents for a RUQ ultrasound due to a positive Casoni Skin Test. What are you looking for on the exam?
a. hydatid cyst
b. metastasis in the liver
c. cirrhosis
d. schistosomiasis
a
97
You are scanning the gallbladder and you obtain images of several echogenic foci within the lumen. What should you do next to better evaluate the findings?
a. have the patient drink water and rescan
b. ask the patient to perform the valsalva maneuver
c. apply color Doppler and obtain a PW sample from the foci
d. change the patient position and rescan
d
98
____ is a hemolytic disorder that causes increased indirect bilirubin levels in the blood.
a. Budd Chiari Syndrome
b. Acute hepatitis
c. Kaposi Sarcoma
d. Anemia
d
99
Alcoholic fatty liver disease demonstrates what difference in lab values from nonalcoholic causes?
a. alcoholic fatty liver disease has no effect on the AST level, but the ALT level is markedly increased
b. alcoholic fatty liver disease demonstrates a much greater increase in LFT levels with an AST/ALT ratio >2
c. alcoholic fatty liver disease demonstrates a much smaller increase in LFT levels with an AST/ALT ratio <1
d. Alcoholic fatty liver disease demonstrates much greater increase in AFP levels
b
100
Which of the following will cause a moderate increase in AFP values in an adult?
a. adenoma
b. glycogen storage disease
c. hepatocellular carcinoma
d. hepatoblastoma
c
101
A 55 year old man presents with a history of Budd Chiari Syndrome. What vessels should be evaluated with Doppler on this exam?
a. aorta
b. hepatic veins
c. renal veins
d. jugular veins
b
102
What lab values will be monitored in patients undergoing treatment for primary liver cancer?
a. bilirubin
b. alanine transaminase
c. alkaline phosphatase
d. alpha fetoprotein
d
103
Which of the following describes a technique that can be used to locate a collapsed gallbladder in a patient with chronic cholecystitis?
a. locate the right portal vein and the main lobar fissure, trace the fissure to the gallbladder neck
b. have the patient perform the Valsalva maneuver to force bile into the gallbladder for improved visualization
c. locate the umbilical vein and trace it to the ligamentum teres to locate the gallbladder neck just medial to the proximal ligamentum
d. use color Doppler to identify the associated hypervascularity seen with wall inflammation
a
104
A patient's chart indicates they have a history of cavernous transformation. Where does this abnormality form?
a. morrison pouch
b. porta hepatis
c. pancreatic tail
d. gallbladder fossa
b
105
Which of the following is a contraindication to placement of a TIPS shunt?
a. hepatocellular carcinoma
b. hepatic artery aneurysm
c. cirrhosis
d. portal thrombosis
d
106
Jaundice is not a clinical symptom of:
a. red blood cell destruction
b. fatty infiltration
c. hepatocellular disease
d. ductal obstruction
b
107
Budd Chiari syndrome, portal thrombosis, and splenomegaly are complications of:
a. anemia
b. increased prothrombin time
c. polycythemia vera
d. steatosis
c
108
Which of the following would cause an increase in serum AST levels with normal serum levels?
a. cirrhosis
b. hepatitis
c. metastasis
d. congestive heart failure
d
109
Which of the following is associated with hyperglycemia?
a. diabetes mellitus
b. islet cell tumor
c. hyperinsulinism
d. pancreatic adenoma
a
110
Which of the following is an appropriate indication for a liver transplant?
a. hepatitis C
b. cholangiocarcinoma
c. extrahepatic malignancy
d. current alcohol abuse
a
111
The liver measurement normally used to assess liver size is:
a. measured from the transverse view at the midclavicular plane
b. the medial to lateral dimension
c. the superior inferior dimension
d. overall volume (l x w x h x 0.5)
c
112
Which of the following is a contraindication for a liver transplant in a patient with hepatocellular carcinoma?
a. more than 2 HCC tumors
b. more than 1 HCC tumor
c. a single primary tumor >5cm
d. the presence of a tumor in the caudate lobe
c
113
A patient presents for an abdominal ultrasound with an order that states "R/O pancreatic endocrine tumor". Which of the following pancreatic tumors can be described as an endocrine tumor?
a. cystadenocarcinoma
b. pseudocyst
c. oncocytoma
d. gastrinoma
d
114
Which of the following can be found on urinalysis of a patient with choledocholithiasis?
a. conjugated bilirubin
b. alpha-fetoprotein
c. unconjugated bilirubin
d. alkaline phosphatase
a
115
Which of the following will help to differentiate hepatocellular carcinoma invasion of the portal vein from portal thrombosis on ultrasound examination?
a. measure the portal vein diameter on inspiration and expiration
b. cannot differentiate thrombus from tumor in the portal vein by ultrasound, requires CT exam
c. measure the portal vein diameter on before and after a fatty meal
d. apply power doppler to the portal vein
d
116
Anemia is a complication of cirrhosis due to associated abnormality of which of the following?
a. diaphragm
b. kidney
c. esophagus
d. aorta
c
117
A patient with multiple gastrinomas will usually present with what other GI tract issue?
a. mesenteric ischemia
b. intussusception
c. peptic ulcer formation
d. esophageal and gastric varices
c
118
A 56 year old male presents with a 4 year history of cirrhosis. The size of which of the following structures should be assessed to evaluate the effects of cirrhosis?
a. portal vein, hepatic vein, and hepatic artery
b. caudate lobe and hepatic artery
c. right lobe, portal vein, and caudate lobe
d. left lobe and caudate lobe
c
119
Which of the following ultrasound exams requires the patient to be NPO for accurate results?
a. abdominal ultrasound for possible rectus sheath hematoma
b. RUQ ultrasound for possible cholecystitis
c. abdominal ultrasound for possible Crohn disease
d. RUQ ultrasound for possible hepatoma
b
120
Which of the following lab values would be elevated with a biliary obstruction due to a hepatocellular carcinoma, but not with biliary obstruction due to choledocholithiasis?
a. alkaline phosphatase
b. alpha fetoprotein
c. gamma glutamyl transpeptidase
d. conjugated bilirubin
b
121
The primary indication for a liver transplant in an adult is ____ and in children _____ is the most common indication for a liver transplant.
a. cirrhosis, hepatitis C
b. hepatitis C, cirrhosis
c. biliary atresia. hepatitis c
d. cirrhosis, biliary atresia
d
122
The best way to differentiate hepatic jaundice from obstructive jaundice is:
a. measure serum levels of alpha-fetoprotein
b. evaluate the liver for tumor formation
c. evaluate the diameter of the biliary tract
d. measure levels of total bilirubin in the blood
c
