Penny chapters 3 & 4 Biliary tree

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. 12 mm c. 14 mm d. 1.5 cm

a. 1 cm

Courvoisier's gallbladder is associated with which of the following: a. a pancreatic head mass b. a stone in the cystic duct c. cholecystitis d. chronic diverticulitis

a. a pancreatic head mass

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 the common hepatic duct d. between the pancreatic head and the duodenum

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

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

a. cholangiocarcinoma

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

Tumefactive sludge can resemble the sonographic appearance of: a. cholelithiasis b. gallbladder caricnoma c. cholecystitis d. adenomyomatosis

a. cholelithiasis

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

The gallbladder is connected to the biliary tree by the: a. cystic duct b. ampulla of vater c. sphincter of oddi d. common bile duct

a. cystic duct

The sequela of acute cholecystitis that is complicated by gas within the gallbladder wall is: a. emphysematous cholecystitis b. membranous cholecystitis c. chronic cholecystitis d. gallbladder perforation

a. emphysematous cholecystitis

The sequela of acute cholecystitis that is found more often in diabetic patients is: a. emphysematous cholecystitis b. gangrenous cholecystitis c. chronic cholecystitis d. gallbladder perforation

a. emphysematous cholecystitis

The middle layer of the gallbladder wall is the: a. fibromuscular layer b. mucosal layer c. serosal layer d. muscularis layer

a. fibromuscular layer

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

Which structure is a useful landmark for identifying the gallbladder? a. main lobar fissure b. hepatoduodenal ligament c. falciform ligament d. ligamentum venosum

a. main lobar fissure

All of the following are sources of diffuse gallbladder wall thickening except: a. malignant ascites b. AIDS c. hepatitis d. adenomyomatosis

a. malignant ascites

Which statement is not true of cholelithiasis? a. men have an increased likelihood of developing cholelithiasis b. patients who have been or are pregnant have an increased occurrence of cholelithiasis c. a rapid weight loss may increase the likelihood of developing cholelithiasis d. patients who have hemolytic disorders have an increased occurrence of cholelithiasis

a. men have an increased likelihood of developing cholelithiasis

Focal tenderness over the gallbladder with probe pressure describes: a. murphy sign b. strawberry sign c. courvoisier sign d. hydrops sign

a. murphy sign

Hartmann pouch involves which part of the gallbladder? a. neck b. fundus c. body d. phrygian cap

a. neck

The junctional fold is found at which level of the gallbladder? a. neck b. fundus c. body d. phrygian cap

a. neck

The most common variant of the gallbladder shape is the: a. phrygian cap b. hartmann pouch c. septated gallbladder d. junctional fold

a. phrygian cap

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

a. pneumobilia

Sonographyically, 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

The diameter of the gallbladder should not exceed: a. 8 cm b. 5 cm c. 7 mm d. 3 cm

b. 5 cm

The merging point of the pancreatic duct and the common bile duct at the level of the 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

The yellow pigment found in bile that is produce by the breakdown of old red blood cells by the liver is: a. alkaline phosphatase b. bilirubin c. cholesterol d. chyme

b. bilirubin

A 32-year-old female patient presents to the sonography department with a history of fever, leukocytosis, and right upper quadrant pain. Sonographyically, 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

What hormone causes the gallbladder to contract? a. estrogen b. cholecystokinin c. bilirubin d. biliverdin

b. cholecystokinin

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

b. choledocholithiasis

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

b. choledocholithiasis

The direct blood supply to the gallbladder is the: a. cholecystic artery b. common hepatic artery c. main portal vein d. cystic artery

b. cystic artery

The spiral valves of Heister are found within the: a. gallbladder neck b. cystic duct c. gallbladder fundus d. gallbladder wall

b. cystic duct

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

b. extrahepatic

What is/are cholelithiasis? a. inflammation of the gallbladder b. gallstones c. hyperplasia of the gallbladder wall d. stones within the biliary tree

b. gallstones

Acute cholecystitis that leads to necrosis and abscess development within the gallbladder wall describes: a. emphysematous cholecystitis b. gangrenous cholecystitis c. chronic cholecystitis d. gallbladder perforation

b. gangrenous cholecystitis

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

The innermost layer of the gallbladder wall is the: a. fibromuscular layer b. mucosal layer c. serosal layer d. muscularis layer

b. mucosal layer

WES sign denotes: a. the presence of a gallstone lodged in the cystic duct b. multiple biliary stones and biliary dilatation c. a gallbladder filled with cholelithiasis d. the sonographic appearance of a porcelain gallbladder

c. a gallbladder filled with cholelithiasis

Cholesterol crystals within the Rokitansky-Aschoff sinuses are found with: a. acute cholecystitis b. acalculous cholecystitis c. adenomyomatosis d. gallbladder perforation

c. adenomyomatosis

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

c. cholangiocarcinoma

An abdominal sonogram is ordered on 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

Intermittent obstruction of the cystic duct by a gallstone results in: a. emphysematous cholecystitis b. gangrenous cholecystitis c. chronic cholecystitis d. acute cholecystitis

c. chronic cholecystitis

A 71-year old patient presents to the emergency department with painless jaundice and an enlarged, palpable gallbladder. These findings are highly suspicious for: a. acute cholecystitis b. chronic cholecystitis c. courvoisier gallbladder d. porcelain gallbladder

c. courvoisier gallbladder

The gallbladder is connected to the biliary tree by the: a. common hepatic duct b. common bile duct c. cystic duct d. right hepatic duct

c. cystic duct

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 choledocholithiasis include all of the following except: a. jaundice b. elevated bilirubin c. elevated blood urea nitrogen d. elevated alkaline phosphatase

c. elevated blood urea nitrogen

A nonmobile, nonshadowing focus is seen within the gallbladder lumen. This most likely represents a: a. gallstone b. gallbladder carcinoma c. gallbladder polyp d. sludge ball

c. gallbladder polyp

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

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

The cystic artery is a branch of the: a. main pancreatic artery b. celiac artery c. right hepatic artery d. left hepatic artery

c. right hepatic artery

The outermost layer of the gallbladder wall is the: a. fibromuscular layer b. mucosal layer c. serosal layer d. muscularis layer

c. serosal layer

The gallbladder wall should measure no more than: a. 5 mm b. 6 mm c. 4 mm d. 3 mm

d. 3 mm

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

d. 5 mm

A 32-year-old female patient presents to the sonography department with vague abdominal pain. The sonographic investigation of the gallbladder reveals a focal area of gallbladder wall thickening that produces comet tail artifact. These findings are consistent with: a. gangrenous cholecystitis b. gallbladder perforation c. acalculous cholecystitis d. adenomyomatosis

d. adenomyomatosis

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

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

d. cholangitis

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. pruritis b. weight loss c. elevated bilirubin d. dilation of the intrahepatic ducts

d. dilation of the intrahepatic ducts

All of the following are sources of diffuse gallbladder wall thickening except: a. benign ascites b. hepatitis c. congestive heart failure d. gallbladder polyps

d. gallbladder polyps

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

d. parabolic