Abdomen Test 3--Gallbladder Flashcards by Mandy Wright

During gallbladder sonography, you notice echogenic foci within the gallbladder but do not detect distal acoustic shadowing. What changes below will improve the detectability of stone shadowing?

A. Increase dynamic range, increase gain

B. Decrease transducer frequency, increase gain

C. Increase transducer frequency, increase transducer focusing

D. Increase output power, decrease transducer frequency

Increase transducer frequency, increase transducer focusing

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The best way to identify the intrahepatic biliary system is to image which structures below?

A. Hepatic veins

B. All fissures and ligaments within the liver parenchyma

C. Intrahepatic portal veins

D. The intrahepatic biliary system can’t be detected sonographically

Intrahepatic portal veins

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Hartmann pouch involves which part of the gallbladder:

A. Fundus

B. Phrygian cap

C. Neck

D. Body

Neck

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A 52 year old man with diabetes is seen with signs and symptoms of severe, acute cholecystitis. The ultrasound findings reveal a gallbladder deviod of stones. The gallbladder wall is thickened, and multiple comet-tail artifacts are identified emanating from the wall. The gallbladder lumen contains low-level echoes from which comet-tail artifacts are also seen. What is the most likely diagnosis?

A. Gallbladder performation

B. Emphysematous cholecystitis

C. Acute cholecystitis

D. Adenomyomatosis

Emphysematous cholecystitis

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The most common level for biliary obstruction to occur is the:

A. Junction of the right and left hepatic ducts

B. Distal common hepatic duct

C. Cystic duct

D. Proximal common hepatic duct

Distal common hepatic duct

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You have been asked to perform an ultrasound to evaluate for biliary obstruction in a patient with a history of weight loss and midepigastric pain. You find both intrahepatic and extrahepatic biliary dilatation. The gallbladder is hydropic. Which of the following conditions causing ductal dilatation should you look for?

A. Choledocholithiasis

B. Pancreatic carcinoma

C. Chronic pancreatitis

D. All of the above

All of the above

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Inflammation of the bile ducts is referred to as:

A. Cholangitis

B. Pneumobilia

C. Choledocholithiasis

D. Cholelithiasis

Cholangitis

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Courvoisier’s gallbladder is associated with which of the following:

A. A pancreatic head mass

B. Cholecystitis

C. A pancreatic head mass

D. Chronic diverticulitis

A pancreatic head mass

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The primary role of the biliary system is

A. To secrete hormones

B. To aid in digestion by storing bile

C. To produce bile

D. To form gallstones

To aid in digestion by storing bile

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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. Jaundice

B. AIDS cholangitis

C. Bilirubinemia

D. Puritis

Jaundice

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Acute cholecystitis that leads to necrosis and abscess development within the gallbladder wall describes:

A. Emphysematous cholecystitis

B. Gangrenous cholecystitis

C. Gallbladder perforation

D. Chronic cholecytitis

Gangrenous cholecystitis

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Tumefactive sludge can resemble the sonographic appearance of:

A. Cholelithiasis

B. Cholecystitis

C. Adenomyomatosis

D. Gallbladder carcinoma

Gallbladder carcinoma

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Air within the biliary tree is referred to as:

A. Cholangitis

B. Pneumobilia

C. Choledocholithiasis

D. Cholesterolosis

Pneumobilia

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A patient presents with jaundice, pain, and fever, secondary to an impacted stone in the cystic duct. This is referred to as:

A. Biliary atresia

B. Caroli’s syndrome

C. Mirizzi syndrome

D. Choledochal cyst

Mirizzi syndrome

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The biliary duct should never measure more than:

A. 6mm

B. 3 mm

C. 4 mm

D. 10 mm

10 mm

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A 32 year old woman with intermittent pain in the RUQ is seen for an abdominal ultrasound. The ultrasound exam reveals a gallbladder with multiple comet-tail artifacts emanating from the gallbladder wall. The lumen of the gallbladder is unremarkable. This most likely represents which of the following?

A. Adenomyomatosis

B. Cholecystitis

C. Cholelithiasis

D. Chlangitis

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Adenomyomatosis

WES sign denotes:

A. The sonographic sign of a porcelain gallbladder

B. Multiple biliary stones and biliary dialation

C. The presence of a gallstone lodged in the cystic duct

D. A gallbladder filled with cholelithiasis

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A gallbladder filled with cholelithiasis

Intermittent obstruction of the cystic duct by a gallstone results in:

A. Chronic cholecystitis

B. Acute cholecystitis

C. Emphysematous cholecystitis

D. Gangrenous cholecystitis

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Chronic cholecystitis

You suspect intrahepatic bile duct dilatation in a patient with right upper quadrant pain and tenderness. How can you differentiate the dilated bile ducts from intrahepatic veins?

A. Dialated bile ducts demonstrate irregular, tortuous walls

B. Bile ducts will not demonstrate flow with color Doppler

C. Intrahepatic portal veins show increased through transmission compared to the dialated bile ducts

D. A and B

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Dialated bile ducts demonstrate irregular, tortuous walls and Bile ducts will not demonstrate flow with color Doppler

Using the attached image. This image was obtained on 85 year old female with jaundice, weight loss, and palpable RUQ mass. What is the best diagnosis?

A. Adenocarcinoma of the gallbladder

B. Hydrops

C. Tumefactive sludge

D. Courvoisier gallbladder

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Adenocarcinoma of the gallbladder

A 74 year old woman is seen with RUQ pain, jaundice, and nausea and vomiting. Ultrasound of the gallbladder reveals cholelithiasis. In addition, a 3 cm, cauliflower shaped mass is seen arising from a stalk within the gallbladder fundus. This is most suggestive of which of the following?

A. Abscess

B. Cholecystitis

C. Gallbladder carcinoma

D. Gallbladder perforation

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Gallbladder carcinoma

Which of the following is not a plausible cause of common bile duct obstruction in adults?

A. Choledochal cyst

B. Choledochalithiasis

C. Pancreatic carcinoma

D. Chronic pancreatitis

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Choledochal cyst

Focal tenderness over the gallbladder with probe pressure describes:

A. Hydrops sign

B. Courvoisier sign

C. Murphy sign

D. Strawberry sign

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Murphy sign

You have been asked to rule out the presence of choledocholithiasis. What are you looking for?

A. Inflammation with thickening of the gallbladder wall

B. Stones within the common bile duct

C. Calcified gallbladder wall

D. Contracted gallbladder filled with stones

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Stones within the common bile duct

## Footnote Which structure is a useful landmark for identifying the gallbladder? A. Falciform ligament B. Main lobar fissure C. Ligamentum venosum D. Hepatoduodenal ligament

Main lobar fissure

## Footnote Cholesterol crystals within the Rokitansky-Aschoff sinuses are found with: A. Acalculous cholecystitis B. Gallbladder perforation C. Adenomyomatosis D. Acute cholecystitis

Adenomyomatosis

## Footnote A renal ultrasound is ordered for a patient in ICU with renal failure, TPN and a long history of hospitalization. During imaging of the right kidney, the sonographer notices that the gallbladder contains low-level echoes that layer and are gravity dependent. This is most consistent with which of the following? A. Cholecystitis B. Sludge C. Abscess D. Cholelithiasis

Sludge

## Footnote What is the most common cause of acute cholecystitis? A. Hepatitis B. Gallstone lodged in the fundus of the gallbladder C. Calculus obstruction of the gallbladder neck or cystic duct D. Pancreatitis

Calculus obstruction of the gallbladder neck or cystic duct

## Footnote A 73 year old woman has RUQ pain, nausea and vomting, and weight loss. Her physician also notes that the whites of her eyes are yellow ans orders and ultrasound of the gallbladder to rule out which of the following? A. Gallbladder carcinoma B. Amebiasis C. Choledocholithiasis D. Adenomyomatosis

Gallbladder carcinoma

## Footnote A 51 year old male is referred for abdominal ultrasound with abnormal liver function tests and jaundice. Which lab work would aid in the differentiation of an intrahepatic versus extrahepatic cause of jaundice? A. Serum alpha-fetoprotein B. Alkaline phosphotase C. Apartate aminotransferase D. Serum bilirubin

Serum bilirubin

Abdomen Test 3--Gallbladder Flashcards

(30 cards)