abdominal final test
The diameter of the portal vein should not exceed:
13mm
What measurement should the normal IVC measure up to and not exceed:
2.5 cm
The aorta is considered to be abnormally enlarged if its dimensions exceed ________ cm.
3cm
The gallbladder wall should measure no more than:
3mm
In a 60-year-old adult, the normal common bile duct should measure around ____mm.
6
An adult patient should fast for _________ hours prior to an ultrasound to examine the aorta.
8
Portal hypertension is due to cirrhosis in ______% of cases.
90
A C/RL ratio of _____ would indicate a normal liver.
<.6
What lab test is a specific indicator of liver disease?
ALT
The main portal vein in its normal state will
Appear above the baseline using spectral doppler
A Klatskin tumor is a form of:
Cholangiocarcinoma
If an obstructive biliary calculus is located within the distal common duct, which of the following could ultimately dilate?
Common bile duct Gallbladder Common hepatic duct
A non mobile, non-shadowing focus is seen within the gallbladder lumen. This most likely represents a:
GB polyp
All of the following are sources of diffuse gallbladder wall thickening EXCEPT: Benign ascites Hepatitis Congestive heart failure Gallbladder polyp
GB polyp
The liver is supplied with blood via the
HA and PV
The sonographic appearance of normal liver parenchyma may be described as
Homogenous with medium-level echoes
What is the last major branch to originate from the aorta prior to the aortic bifurcation?
IMA
Right sided heart failure often leads to enlargement of the:
IVC and hepatic veins
The clinical signs of leg edema, low back pain, pelvic pain, gastrointestinal complaints, and renal and liver problems may represent:
IVC thrombus
Which of the following statements is TRUE regarding the common bile duct?
It is formed by the confluence of the cystic and common hepatic ducts.
The superior mesenteric vein and the splenic vein join to form the:
MPV
The sonographic appearance of cholelithiasis is best described as:
Mobile, hyperechoic focus demonstrating posterior shadowing
An aneurysm associated with infection is termed:
Mycotic
Which is a route for bacteria to gain access to the liver for abscess formation?
PV and HA
Enlargement of the IVC, with subsequent enlargement of the hepatic veins, is seen in cases of:
Right-sided heart failure
The vessel that arises from the anterior aortic wall and takes a parallel course to the aorta is the:
SMA
What vessel passes anterior to the third part of the duodenum and posterior to the neck of the pancreas?
SMV
The portal vein is formed by the confluence of the
SV, SMV, IMV
Which of the following vascular structures relates to the medial and posterior borders or to the pancreatic body and tail?
Splenic vein
Vascular ultrasound agents enhance Doppler flow signals by
adding more and better acustic scatters to the bloodstream
A condition causing RUQ pain in which small polypoid masses with a comet tail artifact arise from the gallbladder wall is:
adenomyomatosis
The three layers that compose the aortic wall are
adventitia, media, initma
The most common cause of cirrhosis is:
alcoholism
This type of abscess should be suspected when patient presents from a high-risk population ( e.g. recent immigrant from an endemic area, patients living in poor sanitary conditions)
amebic
In cases of choledocholithiasis, stones tend to lodge in the:
ampulla of vater
The common bile duct is joined by the main pancreatic duct. Together they open through the _____ into the duodenal wall.
ampulla of vater
Thick, viscid bile (sludge) within the gallbladder indicates
an incidental finding sometimes linked to GB pathology
What is the most common cause of an abdominal aortic aneurysm?
artherosclerosis
The Klatskin tumor is located:
at the junction of the right and left hepatic ducts
If there is an interruption of the IVC, which vascular structure will take over its "job"?
azygos
What vessel will take over if there is a disruption with the IVC so that blood can enter the heart?
azygos veins
Most of the research and development of ultrasound contrast agents has centered on creating agents that can:
be administered intravenously
Fora a vascular ultrasound contrast agent to be clinically useful, it should
be nontoxic have microbubbles that are small enough to traverse the pulmonary capillary beds be stable enough to provide multiple recirculations
A congenital disease in which there is narrowing or obliteration of the bile ducts is referred to as:
biliary atresia
The yellow pigment found in bile that is produced by the breakdown of old red blood cells by the liver is:
bilirubin
Gas-forming bacteria in the gallbladder appear on ultrasound as:
bright echo with a comet tail artifact
Immunocompromised patients are more prone to develop what form of hepatic abnormality?
candidiasis
Lab values used in clinical correlation of vascular pathology can include all of the following EXCEPT: Cholesterol LFT's Hematocrit Carcinoembryonic Antigen
carcinoembryonic antigen
What is the smallest lobe of the liver?
caudate
Which lobe of the liver is least affected with Budd-Chiari Syndrome?
caudate lobe
__________________is the liver segmentation system that divides the liver into eight segments.
cauninaid anatomy
Which of the following actions should be done to image the near field of the liver?
change from sector to a linear transudcer
A 64- year old man presents to the sonography department for a right upper quadrant sonogram. He is complaining of abdominal pain, weight loss, and pruritus. Sonographically, you visualize an area of dilated ducts that abruptly end. What is the most likely diagnosis?
cholangiocarcinoma
The type of tumor that arises from the bile ducts to account for 10% of all primary liver cancers is
cholangiocarcinoma
Patients positive for the AIDS virus are at risk for developing:
cholangitis
A positive Murphy sign is a clinical finding associated with:
cholecystitis
Inflammation of the gallbladder is:
cholecystitis
What hormones cause the gallbladder to contract?
cholecystokin
A fusiform dilation of the common bile duct that causes obstruction is known as:
choledochal cyst
Which condition is associated with an increased risk of hepatocellular carcinoma?
cirrhosis
Which of the following is a common site for a primary cancer which can then spread to the liver?
colon
A choledochal cyst is an abnormality of the
common bile duct
The gastroduodenal artery originates from the:
common hepatic artery
The right and left hepatic ducts emerge from the right lobe of the liver in the porta hepatis and unite to form the;
common hepatic duct
Sonographic findings of acute cholecystitis include all of the following EXCEPT: Positive Murphy's sign Thickened gallbladder wall Hydrops Contracted gallbladder filled with stones
contracted gallbladder filled with stones
The arterial supply to the gallbladder is via the:
cystic artery
The direct blood supply to the gallbladder is the:
cystic artery
The gallbladder is connected to the biliary tree by the:
cystic duct
The valves of Heister are tiny valves found with the:
cystic duct
The common hepatic duct is joined by the _____ to form the _____.
cystic duct and CBD
The physiologic effect of a fatty meal includes all of the following EXCEPT: Stimulation of cholecystokinin (CCK) Contraction of the gallbladder Decrease bile flow to the liver Relaxation of the sphincter of Oddi
decrease bile flow to the liver
Typical symptoms a patient may have with an abscess formation include all of the following EXCEPT: Fever Decreased white blood count Pain Increased white blood count
decreased white blood count
The most common level for biliary obstruction to occur is the
distal common bile duct
One sonographic method used to distinguish dilated bile ducts involves demonstrating the
double barrel shot gun sign
The first ultrasound contrast agent to receive FDA approval was used in
echocardiography
Clinical findings of choledocholithiasis include all of the following EXCEPT: Jaundice Elevated bilirubin Elevated blood urea nitrogen Elevated alkaline phosphatase
elevated blood urea nitrogen
Clinical findings of fatty infiltration of the liver include:
elevated liver tests
The sequela of acute cholecystitis that is complicated by gas within the gallbladder wall is:
emphysematous cholecystitis
The right, left, and middle hepatic veins
empty into IVC
Which segment of the biliary tree tends to dilate first with obstruction?
extrahepatic
Fs indicative of GB disease
fat fertile forty female flatulent fair skin
Sonographically, when the liver is difficult to penetrate and diffusely echogenic, this is indicative of:
fatty liver
Why does the Portal System have echogenic walls?
fibrous tissue
The left hepatic vein and the _____ separate the left hepatic lobe form the caudate.
fissure for the ligamentum teres
What benign liver tumor is located near the free edge of the liver, solitary, well-circumscribed, and a nonencapsulated multi nodular mass?
focal nodular hyperplasia
A Phyrgian cap of the gallbladder is:
folding of the fundus
_____ aneurysm is a uniform dilation of the vessel.
fusiform
What is/are cholelithiasis?
gallstones
Acute cholecystitis that leads to necrosis and abscess development within the gallbladder wall describes:
gangrenous cholecystitis
Empyema of the gallbladder refers to
gas or pus filled gallbladder
The celiac trunk originates within the first 2 cm from the diaphragm and immediately branches into all of the following except: Splenic artery Left gastric artery Common hepatic artery Gastroduodenal artery
gastroduodenal artery
Which of the following structures can be seen entering the pancreatic head?
gastroduodenal artery
The liver is covered by a thin membrane of collagenous fibers called
gilssons capsule
A gallbladder that folds near the area of the neck is called:
hartmann pouch
The most common benign liver tumor is a(n)
hemangioma
Variants of the liver include each of those listed EXCEPT: Reidel's lobe situs inversus hemangioma papillary process
hemangioma
Classic symptoms of gallbladder disease include all of the following EXCEPT: Hematuria RUQ pain Right shoulder pain Nausea and vomiting
hematuria
All of the following are sequela of cirrhosis EXCEPT: Portal vein thrombosis Hepatic artery enlargement Portal hypertension Ascites
hepatic artery enlargment
Budd-Chiari demonstrates thrombosis of the:
hepatic veins
The Budd-Chiara syndrome refers to:
hepatic venous outflow obstruction
You are scanning a patient with a history of fever, abnormal liver function tests, and RUQ pain. The liver is enlarged with decreased echogenicity, the GB wall is thickened. Which of the following conditions is most likely?
hepatitis
The most common liver mass found in children is:
hepatoblasoma
An AFP test is most likely to be abnormal with which liver disease?
hepatocellular carcinoma
_________ defines blood flow away from the live
hepatofugal
A cyst within a cyst (daughter cyst) is a classic example of:
hydatid cyst
You are scanning a patient to rule out fatty liver. Which of the following describes a common sonographic appearance of this condition?
increased echogenicity of the liver compared to the normal right kidney
The portal veins carry blood from the _________ to the liver.
intestinal tract
If an obstruction is located within the distal common hepatic duct, which of the following would become dilated?
intrahepatic ducts
The liver is a(n) structure except for the bare area.
intraperitoneal
Which one of the following describes the most common sonographic appearance of gallbladder carcinoma?
irregular echogenic mass projecting from the gallbladder wall
Elevation of serum bilirubin results in:
jaundice
The most common tumor sites that can spread carcinoma to the biliary tree include all of the following EXCEPT the: Colon Breast Melanoma Kidney
kidney
The portal venous system receives blood from all of the following EXCEPT the: Kidneys Spleen Gallbladder Pancreas
kidneys
All of the following blood vessels empty into the inferior vena cava (IVC), EXCEPT: Right gonadal vein Left renal vein Hepatic veins Left gonadal vein
left gonadal vein
On a transverse view of the mid abdomen, which of the following can be seen coursing between the aorta and the SMA?
left renal vein
What ligament divides the left lobe of the liver into medial and lateral segments?
ligament teres
The falciform ligament extends from the umbilicus to the diaphragm in a parasagittal plane containing the:
ligamentum teres
The umbilical vein after birth becomes the:
ligamentum teres
Shortly after birth, the ductus venosus collapses and becomes the:
ligamentum venosum
The most common site for echinococcal virus growth is in the:
liver
The bright linear echo within the liver connecting the gallbladder and the right or main portal vein is called the:
main lobar fissure
Which structure is a useful landmark for identifying the gallbladder?
main lobar fissure
A hepatoma is a:
malignant tumor of the liver
The hepatoblastoma is a:
malignant tumor of the pediatric liver
The left portal vein divides into:
medial and lateral branches
The liver is a major center of __________, which may be defined as the physical and chemical process whereby foodstuffs are synthesized into complex components.
metabolism
Which of the following is the most common type of malignancy in the liver?
metastases
All of the following are located within the porta hepatis EXCEPT: Main portal vein Common bile duct Hepatic artery Middle hepatic vein
middle hepatic vein
A patient presents with jaundice, pain, and fever, secondary to an impacted stone in the cystic duct. This is referred to as:
mirizzi syndrome
Hartmann pouch involves which part of the gallbladder:
neck
The junctional fold is found at which level of the gallbladder:
neck
The cystic duct connects the _____ of the gallbladder with the common hepatic duct to form the ______.
neck and CBD
When demonstrating a pseudo aneurysm on ultrasound, the sonographer should try to demonstrate which of the following things?
neck connecting the mass to the vessel
Clinical findings of an abdominal aortic aneurysm include all of the following EXCEPT: Lower extremity pain Back pain Neck pain Abdominal bruit
neck pain
Which is the correct order of anatomy from anterior to posterior?
pancrease, SMA, left renal vein, aorta
Courvoisier's gallbladder is associated with
pancreatic head mass
Thickening of the gallbladder wall may be caused by all of the following EXCEPT:
pancreatitis
The inferior extension of the caudate lobe is referred to as:
papillary process
All of the following are forms of cholangitis EXCEPT: Acute bacterial AIDS Oriental Parabolic
parabolic
The distal duct lies ____ with the anterior wall of the inferior vena cava (IVC).
parallel
Air within the biliary tree, secondary to common bile duct stents, is called:
pneumobilia
Non-shadowing, non mobile, echogenic foci attached to the gallbladder wall most likely represent
polyp
A thick calcified gallbladder wall describes which one of the following conditions?
porcelain gallbladder
The vascular branches seen scattered throughout the liver parenchyma are
portal and hepatic veins
During an ultrasound exam, a sonographer identifies a patent lumen within the umbilical vein. This finding may be associated with:
portal hypertension
Which of the following can cause hepatofugal flow in the portal vein?
portal hypertension
Blood is supplied to the liver via the:
portal vein and hepatic arter
Cavernous transformation of the portal vein is a consequence of ____________.
portal vein thrombosis
portal triad
portal vein, hepatic artery, bile duct
Which of the following is true concerning the portal veins?
portal veins have brighter walls than the hepatic veins
The caudate lobe is located on which surface of the liver?
posterior
_______ is a trauma induced disruption of all 3 wall layers.
pseudoaneurysm
The medial portion of the left lobe is also referred to as the
quadrate lobe
All of the following are clinical findings of hepatocellular carcinoma EXCEPT: reduction in AFP unexplained weight loss fever cirrhosis
reduction in AFP
The ligamentum venosum is all of the following EXCEPT: Divides caudate lobe from left lobe of liver Is a remnant of the umbilical vein Is a remnant of the ductus venosus Is a remnant of the fetal circulation which shunted oxygenated blood from the umbilical vein to the IVC bypassing the liver
remnant of the umbilical vein
The most common tumor to fill the IVC is
renal cell carcinoma
Which of the following is a function of the gallbladder?
reservoir for bile
The inferior vena cava (IVC) forms at the confluence of
right and left common iliac veins
The middle hepatic vein divides the liver into
right and left lobes
The right portal vein branches into the
right anterior and posterior portal veins
The right portal vein branches into the following:
right anterior and posterior portal veins
The IVC courses anteriorly to enter the:
right atrium
The cystic artery is a branch of the
right hepatic artery
You are performing an ultrasound on a patient with a transjugular intrahepatic portosystemic shunt (TIPS). What two vessels are commonly connected with the TIPS stent?
right portal vein and right hepatic vein
On a longitudinal view, which of the following may be visualized posterior to the IVC?
right renal artery
From the list below, which vessel would be the shortest in length?
right renal vein
A parasitic disease of the liver causing portal hypertension and occlusion of the portal vein is:
schistosomiasis
The common bile duct is joined by the pancreatic duct as they enter the:
second portion of the duodenum
Echinococcal cysts have the highest incidence in countries in which:
sheep grazing is common
The best way of delineating a dissecting aneurysm on sonography is to
show the initimal flap
Which one of the following is most characteristic of non-shadowing, low amplitude echoes in a dependent gallbladder?
sludge
Which of the following veins begins at the hilum of the spleen and is joined by the short gastric and left gastroepiploic vein?
splenic
Fatty infiltration is often patchy or focal. A less affected region of the liver is called
spread
What are the standard patient positions to assess for Gallstones?
supine LLD
Which of the following statements about the IVC is not true? The diameter of the IVC is variable Respiration can affect the size of the IVC The IVC is considered retroperitoneal in location The IVC is located to the left of the abdominal aorta
the IVC is located to the left of the abdominal aorta
The liver is intraperitoneal except for interruptions at the gallbladder fossa, porta hepatis, and falciform ligament, portions around the IVC, and______.
the bare area
All of the following are characteristics of the hepatic veins EXCEPT: They have echogenic walls All three are best seen on transverse scan They increase in caliber as they approach the diaphragm They can be traced to the IVC
they have echogenic walls
The portal veins can be distinguished from hepatic veins by their
thicker wall and echogenic rim surrounding them
Reidel's lobe is a normal liver variant defined as a(n)
tongue like extension of the right lobe of the liver
On which of the following sonographic planes are all three hepatic veins best visualized at one time
transverse close to the diaphragm
Elastography is an emerging technique that provides a non-invasive method of evaluating elasticity or stiffness of tissue.
true
Hepatic Veins increase in diameter towards the IVC?
true
Which ligament separates the left lobe from the caudate lobe?
venosum