The Pennys Book Chapter 4 Review Questions- The Bile Ducts

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

a. 1 cm

56. What is the most common form of cholangiocarcinoma? a. Adenocarcinoma b. Squamous cell carcinoma c. Melanoma d. Serous cystadenocarcinoma

a. Adenocarcinoma

59. The pathology in Figure 4-15 was identified in a patient complaining of right upper quadrant pain and fever. What do the arrows most likely represent? a. Bile duct sludge b. Cholangitis c. Choledocholithiasis d. Intrahepatic thrombus

a. Bile duct sludge

1. A congenital disease that is described as narrowing or obliteration of the bile ducts is referred to as: a. Caroli disease b. Mirizzi disease c. choledochal cysts d. biliary atresia

a. Caroli disease

14. 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. choledochal cysts c. biliary atresia d. Mirizzi syndrome

a. Caroli disease

30. Which of the following is not associated with the development of pneumobilia? a. Cholangiopneumonia b. Gastric surgery c. Acute cholecystitis d. Fistula formation

a. Cholangiopneumonia

4. Which of the following is associated with Charcot triad? a. Cholangitis b. Cholesterolosis c. Klatskin tumor d. Choledochal cyst

a. Cholangitis

20. 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

18. 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

54. What is the most common location of choledocholithiasis? a. Near the ampulla of Vater b. Near the pancreatic neck c. Within the common hepatic duct d. Within the proximal common bile duct

a. Near the ampulla of Vater

26. 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. Choledocholithiasis c. Sludge balls d. Cholesterolosis

a. Pneumobilia

47. Which of the following is associated with a biliary obstruction? a. Posthepatic jaundice b. Prehepatic jaundice c. Hepatic jaundice d. Biliary jaundice

a. Posthepatic jaundice

43. Which of the following clinical findings would be least likely noted concerning the patient in Figure 4-13? a. Triangular cord sign b. Jaundice c. Elevated bilirubin d. Elevated ALP

a. Triangular cord sign

10. 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

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

a. pneumobilia

50. Sever itchiness of the skin is referred to as: a. pruritus b. kernicterus c. cellulitis d. subcutaneous edemitis

a. pruritus

55. Which type of cholangitis is found in severely immunocompromised patients and results from infections caused by Cryptosporidium or cytomegalovirus? a. Sclerosing cholangitis b. AIDS cholangitis c. Oriental cholangitis d. Acute bacterial cholangitis

b. AIDS cholangitis

25. 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

21. Which of the following could accidentally introduce bacteria into the biliary tree and thus cause cholangitis? a. Computed tomography b. ERCP c. Magnetic resonance imaging d. Radiography

b. ERCP

34. Which segment of the biliary tree tends to dilate first with obstruction? a. Intrahepatic b. Extrahepatic

b. Extrahepatic

12. 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 cysts d. biliary atresia

b. Mirizzi syndrome

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

b. ampulla of Vater

37. 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

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

b. cholangiocarcinoma

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

b. choledocholithiasis

58. Infants with biliary atresia often ultimately suffer from: a. choledocholithiasis b. cirrhosis c. cholecystitis d. pneumobilia

b. cirrhosis

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

b. ring-down artifact

8. 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

35. 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

60. Which of the following is the major component of bile? a. Salt b. Spent hepatocytes c. Cholesterol d. Amylase

c. Cholesterol

57. How is ascariasis transmitted? a. Blood transfusion b. Contaminated water c. Fecal-oral route d. Inhalation of spores

c. Fecal-oral route

44. What does the arrow in Figure 4-14 indicate? a. Cystic artery b. Cystic duct c. Hepatic artery d. Common hepatic duct

c. Hepatic artery

17. 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

41. The patient in Figure 4-12 recently underwent surgery following a bout of emphysematous cholecystitis. Which of the following is the most likely etiology of the pathology noted by the arrows? a. Biliary atresia b. Cholangitis c. Pneumobilia d. Choledochal cysts

c. Pneumobilia

16. 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

53. Which of the following is the most common risk factor for cholangiocarcinoma? a. Pruritus b. Biliary atresia c. Sclerosing cholangitis d. Choledocholithiasis

c. Sclerosing cholangitis

2. 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

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

c. cholangiocarcinoma

28. An abdominal sonogram is ordered for an infant in the intensive care unit who is suffering from jaundice and fever. Sonographically, you visualize an anechoic 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

24. 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.

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

c. elevated blood urea nitrogen

9. 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

23. 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

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

d. 5 mm

42. Which of the following is associated with the "pseudogallbladder" sign? a. Biliary strictures b. Charcot triad c. Pruritus d. Biliary atresia

d. Biliary atresia

27. 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

46. Which of the following is a fluoroscopic procedure typically performed in the radiology department that involves an analysis of the biliary tree and pancreas? a. MRCP b. ERCP c. Nuclear medicine cholangiography d. Cholangiofluoroscopy

d. Cholangiofluoroscopy

45. What pathology can be noted in Figure 4-14? a. Choledocholithiasis b. Cholecystitis c. Pneumobilia d. Cholangitis

d. Cholangitis

38. 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 syndrome c. Caroli disease d. Choledochal cyst

d. Choledochal cyst

40. 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

49. Among the following list, which of the following is located just distal to the cystic duct? a. Right hepatic duct b. Common hepatic duct c. Duct of Wirsung d. Common bile duct

d. Common bile duct

22. If an obstructive biliary calculus is located within the distal common duct, which of the following could ultimately dilate? a. Common bile duct only b. Gallbladder and cystic duct c. Common hepatic duct and intrahepatic ducts d. Common bile duct, gallbladder, common hepatic duct, and intrahepatic ducts

d. Common bile duct, gallbladder, common hepatic duct, and intrahepatic ducts

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

d. Creatinine

48. What is another name for the sphincter of Oddi? a. Vatorial sphincter b. Proximal duodenal sphincter c. Common biliary sphincter d. Hepatopancreatic sphincter

d. Hepatopancreatic sphincter

52. Which of the following is not a sonographic finding of cholangitis? a. Biliary dilatation b. Biliary sludge c. Choledocholithiasis d. Triangular cord sign

d. Triangular cord sign

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

d. cholangitis

15. 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

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

d. dilation of the intrahepatic ducts

51. Enlargement of the common bile duct and pancreatic duct is referred to as the: a. double-barrel shotgun sign b. parallel tube sign c. Mirizzi sign d. double-duct sign

d. double-duct sign

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

d. parabolic