Chapter 4: THE BILE DUCTS review questions

For patients older than age 60, or those who have had a cholecystectomy, a maximum diameter of __ may be considered normal. a.) 1 cm b.) 12mm c.) 14 mm d.) 1.5 cm

a.) 1 cm

If a gallstone, causing obstruction, is located within the distal common hepatic duct, which of the following would become dilated? a.) main pancreatic duct b.) gallbladder only c.) intrahepatic ducts d.) distal common bile duct

c.) intrahepatic ducts

The yellowish staining of the whites of the eyes and the skin secondary to a liver disorder or biliary obstruction is referred to as: a.) AIDS cholangitis b.) pruritus c.) jaundice d.) bilirubinemia

c.) jaundice

Which of the following is characterized by fibrotic thickening of the bile ducts, found most often in young males, and is associated with inflammatory bowel disease or ulcerative colitis? a.) ulcerative biliary atresia b.) oriental cholangitis c.) sclerosing cholangitis d.) AIDS biliary atresia

c.) sclerosing cholangitis

Which of the following disorders is associated with the sonographic triangular cord sign? a.) cholangitis b.) choledocholithiasis c.) biliary atresia d.) ascariasis

c.) biliary atresia

The biliary duct wall should never measure more than: a.) 2mm b.) 9mm c.) 4mm d.) 5mm

d.) 5mm

The presence of an echogenic dot in the nondependent part of a dilated duct representing small fibrovascular bundles is seen with: a.) Caroli disease b.) choledochoal cysts c.) biliary atresia d.) Mirizzi syndrome

a.) Caroli disease

The Klatskin tumor is located: a.) at the junction of the right and left hepatic ducts b.) at the junction of the cystic and common bile duct c.) at the junction of the common bile duct and common hepatic duct d.) between the pancreatic head and the duodenum

a.) at the junction of the right and left hepatic ducts

Which of the following is not associated with the development of penumobilia? a.) cholangiopneumonia b.) gastric surgery c.) acute cholecystitis d.) fistula formation

a.) cholangiopneumonia

Which of the following is associated with Charcot triad? a.) cholangitis b.) cholesterolosis c.) Klatskin tumor d.) choledochal cyst

a.) cholangitis

Which of the following would be the most distal portion of the biliary tree? a.) common bile duct b.) common hepatic duct c.) gallbladder d.) intrahepatic radicles

a.) common bile duct

Which of the following is considered the most proximal portion of the biliary tree? a.) intrahepatic radicles b.) cystic duct c.) common hepatic duct d.) common bile duct

a.) intrahepatic radicles

Air within the biliary tree is referred to as: a.) pneumobilia b.) cholangitis c.) biliary atresia d.) cholesterolosis

a.) pneumobilia

Sonographically, you visualize scattered echogenic linear structures within the liver parenchyma that produce ring-down artifact. What is the most likely diagnosis? a.) pneumobilia b.) choledocholithasis c.) sludge balls d.) cholesterolosis

a.) pneumobilia

A patient presents with jaundice, pain, and fever secondary to an impacted stone in the cystic duct. This is referred to as: a.) Caroli syndrome b.) Mirizzi syndrome c.) choledochal cyst d.) biliary atresia

b.) Mirizzi syndrome

The merging point of the pancreatic duct and common bile duct at the level of the duodenum is: a.) sphincter of Oddi b.) ampulla of Vater c.) common bile duct d.) cystic duct

b.) ampulla of Vater

The yellowish pigment found in bile that is produced by the breakdown of old red blood cells by the liver is: a.) biliverdin b.) bilirubin c.) cholesterol d.) chyme

b.) bilirubin

A Klatskin tumor is a form of: a.) lymphocytic carcinoma b.) cholangiocarcinoma c.) pancreatic carcinoma d.) gallbladder carcinoma

b.) cholangiocarcinoma

A 32 year old female patient presents to the sonography department with a history of fever, leukocytosis, and right upper quadrant pain. Sonographically, you visualize dilated bile ducts that have thickened walls and contain sludge. What is the most likely diagnosis? a.) choledocholithiasis b.) cholangitis c.) Mirizzi syndrome d.) biliary atresia

b.) cholangitis

A gallstone located within the biliary tree is referred to as: a.) cholecystitis b.) choledocholithiasis c.) cholangitis d.) cholangiocarcinoma

b.) choledocholithiasis

Which of the following could accidentally introduce bacteria into the biliary tree and this cause cholangitis? a.) computer tomography b.) endoscopic retrograde cholangiopancreatography c.) magnetic resonance imaging d.) radiography

b.) endoscopic retrograde cholangiopancreatography

Which segment of the biliary tree tends to dilate first with obstruction? a.) intrahepatic b.) extrahepatic

b.) intrahepatic

Pneumobilia will produce: a.) through transmission b.) ring-down artifact c.) acoustic shadowing d.) edge artifact

b.) ring-down artifact

Ascariasis is: a.) a form of biliary tree carcinoma b.) a congenital disorder characterized by segmental dilatation of the intrahepatic ducts c.) caused by a parasitic roundworm d.) a type of ringworm that invades the liver

c.) caused by a parasitic roundworm

Primary biliary tree cancer is referred to as: a.) gallbladder carcinoma b.) biloma c.) cholangiocarcinoma d.) lymphangioma

c.) cholangiocarcinoma

An abdominal sonogram is ordered for an infant in the intensive care unit who is suffering from jaundice and fever. Sonographically, you visualize a cystic mass within the common bile duct that is causing a focal enlargement. This is most suggestive of: a.) cholangiocarcinoma b.) Mirizzi syndrome c.) choledochal cyst d.) biliary atresia

c.) choledochal cyst

Which of the following is not a plausible cause of common bile duct obstruction in adults? a.) choledocholithiasis b.) chronic pancreatitis c.) choledochal cyst d.) pancreatic carcinoma

c.) choledochal cyst

The most common level for biliary obstruction to occur is the: a.) junction of the right and left hepatic ducts b.) proximal common hepatic duct c.) distal common bile duct d.) cystic duct

c.) distal common bile duct

Clinical findings of choledocholithasis include all of the following except: a.) jaundice b.) elevated bilirubin c.) elevated blood urea nitrogen d.) elevated ALP

c.) elevated blood urea nitrogen

The muscle that controls the emptying of bile and pancreatic juices into the duodenum is the: a.) cystic duct b.) ampulla of Vater c.) sphincter of Oddi d.) common bile duct

c.) sphincter of Oddi

If an obstructive biliary calculus is located within the distal common bile duct, which of the following could ultimately dilated? a.) common bile duct b.) gallbladder c.) common hepatic duct d.) all of the above

d.) all of the above

a congenital disease in which there is narrowing or obliteration of the bile ducts is referred to as: a.) Caroli disease b.) Mirizzi disease c.) Choledochal cyst d.) biliary atresia

d.) biliary atresia

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? a.) biliary atresia b.) choledocholithiasis c.) Caroli syndrome d.) cholangiocarcinoma

d.) cholangiocarcinoma

Inflammation of the bile ducts is referred to as: a.) pneumobilia b.) choledocholithiasis c.) cholelithiasis d.) cholangitis

d.) cholangitis

Which of the following is typically found in pediatric patients and is described as the cystic dilation of the common bile duct? a.) biliary atresia b.) Mirizzi syndome c.) Caroli disease d.) choledochal cyst

d.) choledochal cyst

Which of the following would be the most common cause of obstructive jaundice? a.) Klatskin tumor b.) cholangiocarcinoma c.) biliary atresia d.) choledocholithiasis

d.) choledocholithiasis

Which of the following would be the least helpful laboratory value to analyze in patients with suspect biliary tract disease? a.) ALT b.) ALP c.) GGT d.) creatinine

d.) creatinine

The spiral valves of Heister are located within the: a.) common bile duct b.) pancreatic duct c.) common hepatic duct d.) cystic duct

d.) cystic duct

All of the following are clinical findings consistent with cholangiocarcinoma except: a.) pruritus b.) weight loss c.) elevated bilirubin d.) dilation of the intrahepatic duct

d.) dilation of the intrahepatic ducts

All of the following are forms of cholangitis except: a.) acute bacterial b.) AIDS c.) oriental d.) parabolic

d.) parabolic