Penny's Book Chapter 3 Review Questions- The Gallbladder

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

b. 5 cm

2. What is the most likely diagnosis for Figure 3-22? a. Acute cholecystitis b. Adenomyomatosis c. Emphysematous cholecystitis d. Gallbladder polyps

b. Adenomyomatosis

11. What hormone causes the gallbladder to contract? a. Estrogen b. Cholecystokinin c. Bilirubin d. Biliverdin

b. Cholecystokinin

53. What condition may increase the likelihood of developing gallbladder carcinoma? a. Porcelain gallbladder b. Chronic cholecystitis c. Hydropic gallbladder d. Gallbladder perforation

b. Chronic cholecystitis

59. Which of the following could be a likely cause of a hydropic gallbladder? a. Multiple gallbladder polyps b. Gallstone in the cystic duct c. Phrygian cap d. Hartman pouch

b. Gallstone in the cystic duct

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

b. cystic duct

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

b. gallbladder carcinoma

19. Empyema of the gallbladder denotes: a. gallbladder hydrops b. gallbladder filled with pus c. gallbladder completely filled with air d. gallbladder completely filled with polyps

b. gallbladder filled with pus

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

b. mucosal layer

24. Patients who suffer from acute cholecystitis that leads to perforation and rupture have a high mortality and morbidity rate secondary to: a. exudate b. peritonitis c. cholesterolosis d. pancreatic carcinoma

b. peritonitis

6. A 34-year-old patient in Figure 3-23 presented with a positive Murphy sign and elevated WBC. What is the most likely diagnosis? a. Acalculous cholecystitis b. Chronic cholecystitis c. Acute cholecystitis d. Emphysematous cholecystitis

c. Acute cholecystitis

10. Which of the following would be least likely to cause focal gallbladder wall thickening? a. Gallbladder polyp b. Adenomyomatosis c. Ascites d. Adhered gallstone

c. Ascites

33. Which of the following would not be a finding of acalculous cholecystitis? a. Gallbladder wall thickening b. Pericholecystic fluid c. Cholelithiasis d. Positive Murphy sign

c. Cholelithiasis

3. 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

44. What produces the hormone cholecystokinin? a. Gallbladder b. Anterior pituitary gland c. Duodenum d. Pancreas

c. Duodenum

56. Which of the following is a result of an accumulation of cholesterol and triglycerides within the gallbladder wall? a. Gallstone b. Gallbladder carcinoma c. Gallbladder polyp d. Xanthogranulomatous cholecystitis

c. Gallbladder polyp

52. Which of the following is associated focal wall necrosis, bulges in the gallbladder wall, sloughing membranes, and ulcerative craters? a. Porcelain gallbladder b. Adenomyomatosis c. Gangrenous cholecystitis d. Emphysematous cholecystitis

c. Gangrenous cholecystitis

51. What is the most likely diagnosis for this asymptomatic patient in Figure 3-24? a. Chronic cholecystitis b. Emphysematous cholecystitis c. Porcelain gallbladder d. Champaign sign

c. Porcelain gallbladder

58. What is another name for empyema of the gallbladder? a. Caroli disease b. Emphysematous cholecystitis c. Suppurative cholecystitis d. Gallbladder hydrops

c. Suppurative cholecystitis

49. Which of the following is a rare chronic gallbladder infection characterized by intramural accumulation of inflammatory cells? a. Gallbladder perforation b. Adenomyomatosis c. Xanthogranulomatous cholecystitis d. Emphysematous cholecystitis

c. Xanthogranulomatous cholecystitis

27. 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 sign of a porcelain gallbladder

c. a gallbladder filled with cholelithiasis

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

c. adenomyomatosis

34. 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

17. 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

30. The champagne sign is associated with: a. adenomyomatosis b. cholangiocarcinoma c. emphysematous cholecystitis d. acalculous cholecystitis

c. emphysematous cholecystitis

1. Hepatization of the gallbladder occurs when the gallbladder: a. perforates b. becomes hydropic c. fills with sludge d. undergoes torsion

c. fills with sludge

36. 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

43. Calcification of the gallbladder wall is termed: a. concrete gallbladder b. Heister syndrome c. porcelain gallbladder d. hyperplastic cholecystosis

c. porcelain gallbladder

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

c. right hepatic artery

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

c. serosal layer

12. The gallbladder wall should measure not more than: a. 5 mm b. 6 mm c. 4 mm d. 3 mm

d. 3 mm

5. Which of the following would not be a laboratory finding typically analyzed with suspected gallbladder disease? a. ALP b. ALT c. Bilirubin d. Alpha-fetoprotein

d. Alpha-fetoprotein

28. Which of the following is the most likely clinical finding of adenomyomatosis? a. Murphy sign b. Hepatitis c. Congestive heart failure d. Asymptomatic

d. Asymptomatic

41. Which of the following would yield a gallbladder with an hourglass appearance? a. Hartmann pouch b. Phrygian cap c. Junctional fold d. Bilobed

d. Bilobed

57. Which of the following is not a section of the gallbladder? a. Neck b. Body c. Fundus d. Head

d. Head

48. Which of the following may not be a clinical or sonographic finding in patients with emphysematous cholecystitis? a. Diabetes b. Gas formation in the wall of the gallbladder c. Fever d. Murphy sign

d. Murphy sign

32. 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

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

d. cystic artery

31. The sequela of acute cholecystitis that is associated with a tear in the gallbladder wall is: a. emphysematous cholecystitis b. membranous cholecystitis c. chronic cholecystitis d. gallbladder perforation

d. gallbladder perforation

25. All of the following are sources of diffuse gallbladder wall thickening except: a. acute cholecystitis b. AIDS c. hepatitis d. gallbladder polyp

d. gallbladder polyp

47. Unconjugated bilirubin may also be referred to as: a. conjugated bilirubin b. total bilirubin c. direct bilirubin d. indirect bilirubin

d. indirect bilirubin

54. Gallbladder carcinoma may be suspected when a gallbladder polyp exceeds: a. 1 cm b. 2 mm c. 5 mm d. 8 mm

a. 1 cm

42. With which of the following is Courvoisier gallbladder associated? a. A pancreatic head mass b. A stone in the cystic duct c. Cholecystitis d. Chronic diverticulitis

a. A pancreatic head mass

45. What is the artifact associated with adenomyomatosis? a. Comet tail b. Reverberation c. Acoustic shadowing d. Twinkle

a. Comet tail

50. Which of the following would most likely be associated with gallstones or biliary tree obstruction? a. Elevated direct bilirubin b. Elevated indirect bilirubin c. Decreased conjugated bilirubin d. Decreased unconjugated bilirubin

a. Elevated direct bilirubin

55. Which of the following would increase the likelihood of suffering from gallbladder torsion? a. Floating gallbladder b. Gallstones c. Acalculous cholecystitis d. AIDS cholangiopathy

a. Floating gallbladder

46. Which of the following is a condition associated with vasculitis and gallbladder hydrops? a. Kawasaki disease b. Beckwith-Wiedemann syndrome c. Sickle cell disease d. Multiple hepatic hemangioma

a. Kawasaki disease

9. 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

26. Which statement is not true of cholelithiasis? a. Men have an increased likelihood of developing cholelithiasis compared to women 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 compared to women

37. Focal tenderness over the gallbladder with probe pressure describes: a. Murphy sign b. strawberry sign c. Courvoisier sign d. hydrops sign

a. Murphy sign

16. Which part of the gallbladder is involved in Hartmann pouch? a. Neck b. Fundus c. Body d. Phrygian cap

a. Neck

18. At which level of the gallbladder is the junctional fold found? a. Neck b. Fundus c. Body d. Phrygian cap

a. Neck

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

a. Phrygian cap

35. Which of the following is not a risk factor for the development of gallstones? a. Phrygian cap b. Pregnancy c. Total parenteral nutrition d. Oral contraceptive use

a. Phrygian cap

13. Which of the following is associated with cholelithiasis and is characteristically found in Africans or people of African descent? a. Sickle cell disease b. Gallbladder torsion c. Cholesterolosis d. Arland-Berlin syndrome

a. Sickle cell disease

60. What clinical finding is not typically associated with gallbladder carcinoma? a. Weight gain b. Hepatomegaly c. Jaundice d. Elevation in ALP

a. Weight gain

21. The diffuse polypoid appearance of the gallbladder referred to as strawberry gallbladder is seen with: a. cholesterolosis b. adenomyomatosis c. cholangitis d. Kawasaki disease

a. cholesterolosis

38. Diabetic patients suffering from acute cholecystitis have an increased risk for developing: a. emphysematous cholecystitis b. gangrenous cholecystitis c. chronic cholecystitis d. gallbladder torsion

a. emphysematous cholecystitis

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

a. fibromuscular layer