Abdomen Finals Review : Liver, Biliary system, Spleen, Pancreas, Kidneys

What controls glucose metabolism ? a. Pancreas b. Spleen c. Biliary system d. Liver

A

What is the basic functional unit of the liver ? a. Hepatic cell b. Liver lobule c. Liver lobe d. Hepatic duct

B

True or FAlse : Alkaline phosphatase levels is used in diagnosing bone as well as liver disease.

TRUE

Approx. how much of the liver's blood is supplied by the hepatic artery ? a. 25 b. 50 c. 30 d. 75

25%- H.A

Approx. how much of the liver's blood is supplied by the portal system ? a. 25 b. 50 c. 30 d. 75

75%- P.V

A 61-yr-old man with elevated bilirubin has several GB calculi and dilated hepatic ducts. What is a likely explanation when sonography visualizes that the RLL has a normal pattern but extends quite far into the abdominal cavity ? a. Reidel's lobe b. Neoplasm c. Abscess d. MEtastases

A

Sonographically, how is the developmental renal anomaly of a duplex collecting system usually identified ? a. A duplicated central renal sinus b. Lymphadenopathy c. Hydronephrosis d. Sinus area is enlarged

A

What disease is caused by parasitic worms that reside in fresh water int he form of larvae ? a. Schistosomiasis b. Malakoplakia c. Tuberculosis d. Candida albicans

A

What is a choledochal cyst ? a. A congenital dilation of the biliary tree b. Associated with polypoid masses c. A true cyst d. Associated with chronic cholecystitis

A

What is a reasonable explanation for a fluid-filled mass sonographically located posterior to the GB ? a. Duodenum b. Cystic duct c. Hepatic flexure d. Transverse colon

A

What is the most common cause of acute cholecystitis ? a. Calculus obstruction of the GB neck or cystic duct b. Calculus lodged in the fundus of GB c. Hepatitis d. HCC

A

What term describes an abnormally dilated, edematous GB ? a. Hydropic b. Tumefactive c. Hematobiliary d. Carcinoma

A

What vessels are used to identify the head of the pancreas ? a. IVC, SMV, GDA b. IVC, AO, RT renal v., GDA c. AO, Portal/Splenic, LT renal v., SMA d. IVC, AO, SMA

A

Where are the kidneys located ? a. Retroperitoneum b. Interperitoneum c. Peritoneum d. Intraperitoneum

A

Where is the largest mass of lymphatic tissue in the body ? a. Spleen b. Liver c. Bladder d. Kidney

A

Which of the following is an important glomerular filtration test ? a. Creatinine clearance b. Specific gravity c. pH d. Protein

A

Which term describes the pancreatic enzyme such as amylase ? a. Exocrine b. Metabolic c. Endocrine d. Storage

A

What is associated with the usual occurence of a Courvoisier GB ? a. Malignant neoplasm at panc head b. Cholecystitis c. Mirizzi syndrome d. Chronic cholecystitis

A Courvoisier GB usually occurs when there is obstruction of CBD typically from a malignant neoplasm (adenocarcinoma) at panc head.

What may be the etiology of anemia ? a. Hypersplenism b. Culling function c. Hyposplenism d. Lymphoma

A Increased blood cell destruction causes anemia

What would be included in the differential diagnosis if the PT presents with jaundice, pruritus, increased direct bilirubin, and alkaline phosphatase are clinical signs and lab values indicative of what differential diagnosis ? a. Carcinoma of CBD b. Malformation of bile salts c. Vit. K deficiency d. Hemangioma

A Jaundice and pruritus are clinical signs of CBD carcinoma. LAb values will show elevated direct bilirubin and ALP. Dilated hepatic ducts will confirm

If the PT is supine and the transducer is placed perpendicular to the pancreas on the ventral abdomen, which interfaces relative to the pancreas affects the pancreatic echogenicity ? a. Anterior b. Superior c. Inferior d. Posterio

A The pancreatic echogenicity is affected by the anterior tissue structures

A 36-yr-old woman is sonographically being examined for gestational dating. She has a high level of alph-fetoprotein and an abnormal hepatocellular function which are inconsisten with the normal progress and normal echo appearance of the pregnancy. Clinically, she has nausea, weight loss, and a palpable RUQ mass. What is the most likely explanation ? a. Cholelithiasis b. Hepatoma c. Hepatic cysts d. Colitis

B

Approx. 80% of the water that is reabsorbed into the blood occurs in what part of the nephron ? a. Collecting tubule b. Prox convoluted tubule c. Loop of Henley d. Distal convoluted tubule

B

Excessive mineral salt ingestion or a decrease in water consumption may result in which of the following substances int he urinary tract that will cause acoustical shadowing ? a. Blood clots b. Calculi c. Ketone bodies d. Casts

B

GB carcinoma is most likely to be associated with which disease ? a. Alcoholic cirrhosis b. Cholelithiasis c. Portal hypertension d. Adenomyomatosis

B

Identifying what anatomic structure would mostly help a sonographer locate a contracted GB ? a. RT hepatic vein b. Main lobar fissure c. Ligamentum teres d. Coronary ligament

B

On TRV plane, the RT portal vein is tha landmark because it separates what liver structures ? a. RT & LT lobes of liver b. RT hepatic anterior and posterior segments c. RT lobe from the porta hepatis d. RT lobe from the caudate lobe

B

On a supine longitudinal section, what organ should be visualized posterior to the LT hepatic lobe and anterior to the splenic artery and vein ? a. LT kidney b. Pancreas c. Spleen d. Caudate lobe

B

The normal adult renal cortex echogenicity is comparable to what two normal organs at the same depth ? a. Liver and pancreas b. Liver and spleen c. Spleen and pancreas d. Liver and adrenal

B

What is a likely explanation for a large palpable LUQ mass seen on a PT with leukocytosis ? a. Asplenia b. Splenomegaly c. Accessory spleen d. Lymphosarcoma

B

What is an explanation if the sonographer is having difficulty visualizing the anterior and inferior portion of the spleen because of shadowing artifacts ? a. Calcified aortic wall b. Air in the LT colic flexure c. Air in the gastric fundus d. Calculi in the LT kidney

B

What is the conduit for lipase and amylase secretions ? a. ISlets of Langerhans b. Duct of Wirsung c. Accessory ducts d. Arterial system

B

What is the most prevalent benign kidney tumor with a similar sonographically appearance to renal cell carcinoma ? a. Tuberous sclerosis b. Cortical adenomas c. Parenchymal renal disease d. Simple renal cysts

B

What is the most useful and most important measurement variable that can be used to detect renal disease and in evaluating the renal allograft ? a. Thickness b. Volume c. Length d. Width

B

What life-threatening condition is correlated with PTs who present with polycystic kidneys ? a. Cysts of the ovary b. Berry aneurysms c. Hepatic cysts d. Lung cysts

B

What sinusoid function removes imperfect RBCs ? a. Kupffer cells b. Macrophage c. Anabolistic d. Metabolistic

B

When the PT is in standard anatomic position, what is the course of the CBD ? a. Vertical b. Longitudinal c. Coronal d. Transverse

B

When visualizing the kidney, where are the superior extremities located relative to the inferior extremities ? a. Anterior b. Medial c. Lateral d. Posterior

B

Which is associated with Caroli disease ? a. Courvoisier GB b. Dilated intrahepatic bile ducts c. Diffuse thickening of the common duct d. Dilated extrahepatic bile ducts

B

Which is the most common congenital pancreatic anomaly ? a. Pseudocysts b. Pancreas divisum c. Neoplasms d. Pancreatitis

B

Which vessels are usually identified first by the fibrous connective tissue that surrounds them and provides a bright echogenic pattern ? a. Hepatic vein b. Portal veins c. Hepatic artery d. AO

B

A slight elevation of alkaline phosphatase is an abnormal finding in which of these patient populations ? a. Orthopedic w/ new bone growth b. Psychiatric w/ dementia c. Pediatric following a tonsillectomy d. Obstetric w. viable fetus

B ALP is normal in A, C, and D

What columns form as early as the 3rd week of embryonic development ? a. Endoderm b. Mesoderm c. Ectoderm d. Medullary

B Columns of Mesoderm

Leukocytosis may result from what condition ? a. Radiation therapy b. Hemorrhage c. Cortisol treatment d. Systemic lupus erythematosus

B Leukocytosis may result from infection, leukemia, hemorrhage, and malignancy

Which is the most likely pathology if multiple echogenic and hypoechoic areas are visualized ? a. Ascites b. Malignant neoplasms c. Cysts d. Hepatoma

B Malignant neoplasms are sometimes the most difficult echo pattern to diagnosis because the presentation can include 1) relatively well-defined hypoechoic masses containing fewer echoes than the adjacent surrounding parenchyma, 2) relatively well-defined echogenic masses containing higher amplitude echoes than the surrounding parenchyma, and 3) diffuse distortion of the normal homogenous parenchymal pattern without focal masses

Where is the pancreas most commonly located with the PT in a supine position ? a Superior to spleen b. Posterior to stomach and duodenum c. Anterior to stomach d. Inferior to the 3rd portion of the duodenum

B Pance is in retroperitoneum so is posterior to stomach and duodenum

Even though the etiology is unknown, which of the following tends to occur after an infection, especially those of the respiratory tract ? a. Glomerulonephron b. Wilms tumor c. Glomerulonephritis d. Pheochromocytoma

C

Focal hypoechoic vascular lesions may be more easily seen employing what technique ? a. Spectral analysis b. Increase focal depth c. Color Doppler d. Gray scale

C

On a longitudinal image, which major vessel courses posterior to the LLL and is to the LT of the midline ? a. Hepatic Artery b. Hepatic vein c. AO d. Portal vein

C

What anatomic structure is located lateral and to the RT of the hepatic artery ? a. Main pancreatic duct b. Portal vein c. CHD d. GDA

C

What condition is abnormal amounts of uric acid in the blood ? a. Azotemia b. Glomerulonephritis c. Hyperuricemia d. Urinary casts

C

What describes a phrygian cap ? a. Kinked haustral folds b. A billed cap refraction artifact c. A kinked or folded back fundus d. Residual GB volume

C

What function of the spleen requires B cells and T cells ? a. Anabolism b. Metabolism c. Immunology d. Culling

C

What is one of the GB's physiologic functions in regard to bile ? a. Produce b. Metabolize c. Concentrate d. Manufacture

C

What is the relationship for the amount of AST in the blood compared to the number of cells damaged and to the time interval between injury and the test ? a. Arbitrary measure b. No specified amount c. Direct proportion d. Indiscriminate value

C

What liver structure has been confused as a pancreatic head mass ? a. Falciform ligament b. Portal triad c. Caudate lobe d. Quadrate lobe

C

What pancreatic tissue is located behind the SMV ? a. Tail b. Body c. Uncinate process d. Anomalous ectopic pancreatic tissue

C

What pathology defines a renal neoplasm composed of immature, undifferentiated cells ? a. GLomerulonephritis b. Nephritis c. Nephroblastoma d. Pheochromocytoma

C

What pathology may be simulated byt he presence of the extrarenal pelvis anomaly ? a. A duplicated central renal sinus b. Lymphadenopathy c. Hydronephrosis d. Enlarged sinus area

C

What tubular structure may indent the IVC and is best visualized on a longitudinal section ? a. LT Renal A. b. LT Renal V. c. RT Renal A. d. RT Renal V.

C

Where is the pancreas located ? a. Peritoneal b. Subphrenic c. Retroperitoneum d. Hypochondriac region

C

Where on the GB would the Hartmann's pouch be located ? a. Body b. Fundus c. Infundibulum d. Tail

C

Which anatomic structure appears abnormal in PT with a choledochal cyst ? a. Pancreatic duct b. GB c. CBD d. Cystic duct

C

Which supplies the liver with blood that is rich in nutrients ? a. AO b. Hepatic artery c. Portal vein d. IVC

C Hepatic artery supplies liver with blood rich in oxygen

The spleen is more susceptible to what pathology where there are no adequate anastomoses between the arteries in the spleen ? a. Aplasia b. Tumor infiltration c. Infarction d. Hemangiomas

C Infarction = hypochondrial pain ; fever ; pleural effusion ; anemia ; elevated leukocytosis ; elevated LDH ; Hypoechoic wedge-shaped

Which vascular structure is retrocaval ? a. RT Renal V b. LT Renal V c. RT Renal A d. LT Renal A

C RRA is posterior to IVC

What structure makes the lateral aspect of the RLL difficult or challenging to visualize ? a. RT kidney b. RT lung c. Costal margin d. GB

C Ribs create artifacts overlying ribs

In cases of hydronephrosis, what renal parenchyma is evaluated to determine how much functioning tissue remains ? a. Pyramids b. Medulla c. Sinus d. Cortex

D

Using Couinaud's method of liver sigmentation, what provides the boundaries for each segment ? a. Ligaments and fissures b. Portal veins c. Hepatic arteries d. Hepatic veins

D

What 2 enzyme levels increase with pancreatitis ? a. Lipase and trypsin b. Amylase and chymotrypsin c. Chymotrypsin and trypsin d. Amylase and lipase

D

What are homogenous masses with cystic internal echo patterns usually attributed to ? a. Growth b. Abscess c. Metastasis d. Necrosis

D

What describes what controls the release of insulin by the pancreas ? a. Production of regulatory lipids b. Positive feedback mechanism c. Mood, emotion, and temperature d. Negative feedback mechanism

D

What disease process results in ruptured erythrocytes ? a. Hemagiomata b. Hematuria c. Homeopathic d. Hemolysis

D

What is the major cause of pancreatic exocrine failure in children ? a. Chronic pancreatitis b. Biliary tract disease c. Pancreatic carcinoma d. Cystic fibrosis

D

What is the normal anatomic location of the spleen ? a. Antecaval region b. Subcostal region c. Retroperitoneum d. Peritoneal cavity

D

What is the normal echo amplitude relationship between the pancreas, kidney, and liver parenchyma (not cortex), starting with the most hyperechoic and progressing to the least hyperechoic ? a. Kidney, pancreas, liver b. Kidney, liver, pancreas c. Pancreas, kidney, liver d. Pancreas, liver, kidney

D

What splenic function removes senescent, defective RBCs ? a. Pitting b. Immun c. Filtration d. Culling

D

When the panc is scanned in a true anatomic TRV body plane, which pancreatic portion is the most inferior ? a. Neck b. Tail c. Body d. Head

D

Where does colon carcinoma usually metastasize ? a. Uterus b. Pancreas c. Retroperitoneal lymphatics d. Liver

D

Which lab value is likely to be abnormal if dilated intrahepatic bile ducts are demonstrated sonographically ? a. Serum amylase b. Serum ALT c. Serum AST d. Serum alkaline phosphatase

D

What is the single most common malignant lesion of the pancreas ? a. Beta cell blastoma b. Islet cell carcinoma c. Lymphomas d. Acinar cell adenocarcinoma

D Adenocarcinomas account for 95% of all pancreatic malignancies.

What is the most significant clinical implication of the elevated BUN ? a. Casts in the urine b. Proteinuria c. 50% plus nephron destruction d. Decreased renal blood supply

D Elevated BUN indicates : 1) acute or chronic renal failure 2) congestive heart failure with decreased blood supply 3) obstructive uropathy 4) combination of 1 to 3

What can be sonographically demonstrated on a PT with histoplasmosis ? a. Adenomas b. Hypoplasia c. Cystic masses d. Calcifications

D Hypoplasia = small, nonfunctional spleen associated with repeated infarction that relates to sickle cell anemia. Spleen will be small, fibrotic, and calcified

RUQ pain, elevated temperature, vomiting, nausea, mild paralytic ileus, and referred pain into the RT shoulder blade is specific to what biliary condition ? a. Cirrhosis b. Atresia c. Colic d. System disease

D It isn't specific enough to determine the name of the disease without further information

What benign hepatic condition is associated with a long history of oral contraceptive usage ? a. Hepatoma b. Hematoma c. Angiomyosarcoma d. Adenoma

D Liver cell adenoma

Choledocholithiasis producing obstructive jaundice would be a differential diagnosis if there is a variance in which lab value ? a. Elevated indirect bilirubin b. Elevated unconjugated bilirubin c. Marked elevated indirect bilirubin d. Marked elevated direct bilirubin

D The liver functioned in this situation, but the bile is not getting from the liver into the bowl

What lab value will verify a PT has acute pancreatitis ? a. Bilirubin b. ALkaline phosphatase c. Hematocrit d. Amylase

D The primary clinical lab value to verify acute pancreatitis is amylase