Clinical #1 Flashcards by lindsay crouse

When evaluating the venous outflow of a liver transplant patient, it is most important to check the surgical history to find ___ before scanning.

what segment of the PV was attached to the HV
what segment of the PV was attached to the IVC
the patient’s current LFT levels and PT
the type of surgical anastomosis

the type of surgical anastomosis

( anastomosis sites are common sites of obstruction )

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Which of the following is associated with hypoglycemia?

oncocytoma
diabetes mellitus
mucinous cystadenoma
islet cell tumor

islet cell tumor

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You are scanning the GB and you obtain images of several echogenic foci within the lumen. What should you do next to better evaluate the findings?

have the patient drink water and rescan
change the patient position and rescan
ask the patient to perform the valsalva maneuver
apply color Doppler and obtain a PW sample

change the patient position and rescan

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Which of the following is an appropriate indication for a liver transplant?

extrahepatic malignancy
Hep C
cholangiocarcinoma
current alcohol abuse

Hep C

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Hypersplenism and anemia are common findings in cases of:

cirrhosis
asplenia
sickle cell disease
celiac disease

cirrhosis

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Which of the following describes the best technique to differentiate a polyp in the GB wall from a stone within the lumen?

apply color Doppler
ask the patient to perform the valsalva maneuver
roll the patient into the LLD position
have the patient drink water and rescan the GB

roll the patient into the LLD position

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Which probe position is used to demonstrate a longitudinal view of the MPV entering the liver?

SAG subcostal position just to the right of midline

oblique subcostal approach with the transducer rotated slightly with the notch side of the transducer angled more superiorly than the side of the probe without the notch

SAG subcostal position just to the left of midline

oblique subcostal approach with the transducer rotated slightly with the notch side of the transducer angled more inferiorly than the side of the probe without the notch side

oblique subcostal approach with the transducer rotated slightly with the notch side of the transducer angled more superiorly than the side of the probe without the notch

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The best way to differentiate hepatic jaundice from obstructive jaundice is:

evaluate the diameter of the biliary duct
measure serum levels of AFP
measure levels of total bilirubin in the blood
evaluate the liver for tumor formation

evaluate the diameter of the biliary duct

( if bile ducts are normal size, the cause of the jaundice is not obstructive )

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A patient with multiple gastrinomas will usually present with what other GI tract issue?

esophageal and gastric varices
mesenteric ischemia
peptic ulcer formation
intussusception

peptic ulcer formation

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A patient is referred for an abdominal ultrasound due to an abnormal CT scan. The yellow arrow indicates the GB. Based on the single CT image, which of the following is an expected finding on the ultrasound evaluation?

extrahepatic ductal obstruction
klatskin tumor
hydropic GB
GB wall thickness >3mm

GB wall thickness > 3mm

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Decreased serum albumin levels are associated with the development of ___.

ascites
kidney stones
thyroid adenomas
epididymitis

ascites

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Which of the following ultrasound exams requires the patient to be NPO for accurate results?

abdominal ultrasound for possible Crohn disease
RUQ ultrasound for possible hepatoma
RUQ ultrasound for possible cholecystitis
ABD ultrasound for possible rectus sheath hematoma

RUQ ultrasound for possible cholecystitis

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A patient presents for an abdominal ultrasound due to elevated LDH and a low grade fever. Which of the following is the most likely finding on the exam?

Wilson disease
steatosis
hepatitis
choledocholithiasis

hepatitis

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Which of the following lab values is usually unaffected by an isolated biliary duct obstruction?

total bilirubin
GGTP
AST
ALP

AST

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Budd Chiari syndrome, portal thrombosis, and splenomegaly are complications of:

anemia
steatosis
polycythemia vera
increased PT

polycythemia vera

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While scanning in the TRV plane of the abdomen, you notice a round anechoic structure just anterior to pancreatic head. Which of the following should be the next step in evaluating this finding?

apply color Doppler
evaluate the kidneys for cysts
have the patient drink water
scan the patient in the decubitus position

apply color Doppler

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A patient is referred for an abdominal ultrasound due to an abnormal CT scan. Refer to the image to determine where will you find the largest liver mass?

caudate lobe
right anterior superior segment
right posterior superior segment
left medial superior segment

right anterior superior segmet

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You are trying to scan the liver from a midline window but there is excessive gas in the GI tract. All of the following techniques can aid in better visualization of the liver, EXCEPT:

ask the patient to take a deep breath and hold it
use graded compression to displace bowel gas
give the patient cholecystokinin
give the patient water and rescan

give the patient cholecystokinin

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Which of the following pancreatic abnormalities will cause an increase in insulin levels in the blood?

acute pancreatitis
pseudocyst
chronic pancreatitis
islet cell tumor

islet cell tumor

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A patient presents for a pre-surgical evaluation of a known pancreatic mass. What is the most important information you need to document for the surgeon?

the number and location of abnormal lymph nodes in and around the porta hepatis

the volume of normal pancreatic tissue present

the volume of the pancreatic mass

if any vessels around the pancreas demonstrate tumor invasion

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Which of the following will cause an increase in alpha-fetoprotein values?

HCC
glycogen storage disease
adenoma
FNH

HCC

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Anemia is a complication of cirrhosis due to associated abnormality of which of the following?

pancreas
kidney
aorta
esophagus

esophagus

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Which of the following liver abnormalities can be related to the use of oral contraceptives?

hepatic adenoma and Budd Chiari
FNH and hepatic adenoma
hydatid disease and schistosomiasis
Budd Chiari and hydatid disease

hepatic adenoma and Budd Chiari

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Applying compression using curvilinear transducer with a large footprint is the key method used to best evaluate:

neonatal hips
the body of the pancreas
a suspected thyroglossal duct cyst
the scrotal wall thickness

the body of the pancreas

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What is the proper patient position and respiration for assessing the PV diameter? LLD position with deep inspiration RLD position with deep inspiration supine with quiet respiration supine with inspiration and Valsalva

supine with quiet respiration

Which liver function level is the most sensitive indicator for alcoholism? GGTP ALT AFP AST

GGTP

The most important structure to evaluate with a liver transplant is: biliary anastomosis HV HA PV

What lab value would be at a normal level in this patient? conjugated bilirubin PT ALP unconjugated bilirubin

unconjugated bilirubin

What liver mass is associated with glycogen storage disease? hamartoma hepatoma adenoma lipoma

adenoma

Charcot triad is used to describe the classic clinical presentation of: Hashimoto thyroiditis acute cholangitis pyloric stenosis abdominal aortic aneurysm

acute cholangitis

AFP values will be increased with: biliary obstruction glycogen storage disease and Wilson disease viral and alcoholic hepatitis malignancy and pregnancy

malignancy and pregnancy

A female patient presents with 8 days of abdominal pain, fever, and nausea. The symptoms started 2 days after returning from a business trip to Hong Kong. Recent lab values demonstrate increased levels of direct serum bilirubin, ALP, and WBCs. These clinical findings are most suggestive of: cholangitis Klatskin tumor primary GB carcinoma pneumobilia

cholangitis

Jaundice is not a clinical symptom of: fatty infiltration ductal obstruction hepatocellular disease RBC destruction

fatty infiltration

Which of the following is required when performing liver elastography? patient should perform a neutral breath hold for a few seconds when recording measurements the region of interest box should be placed on the liver tissue within 2cm of the skin surface patient should perform the Valsalva maneuver for a few seconds when recording measurements the region of interest box should be placed on the liver tissue within 2cm of the diaphragm

patient should perform a neutral breath hold for a few seconds when recording measurements

A patient presents for an abdominal ultrasound due to loss of appetite, weight loss and epigastric pain. A hypoechoic mass is identified in the anterior aspect of the head of the pancreas. Which of the following best describes the next step in evaluating this patient? review the patient chart to view the pancreatic enzyme levels related to acute pancreatitis apply color Doppler to the area to determine if the hypoechoic area is a possible portal thrombosis evaluate the surrounding areas for lymphadenopathy evaluate the GB for stones

evaluate the surrounding areas for lymphadenopathy

A patient presents for an abdominal US to verify findings identified on a CT exam. The CT report indicates numerous cystic structures throughout the liver that do not communicate with the biliary tree or the vascular system. Which of the following best describes the expected US findings? Caroli disease Budd Chiari choledochal cysts polycystic disease

polycystic disease

What is the proper caliper placement for assessing the PV diameter? outer wall to outer wall at the junction of the splenic vein and PV inner wall to inner wall at the point the PV crosses the IVC outer wall to outer wall at the point the PV crosses the IVC inner wall to inner wall at the junction of the splenic vein and PV

inner wall to inner wall at the point the PV crosses the IVC

When scanning the pancreas, which of the following techniques will not assist in reducing the gas artifact around the pancreas? NPO 8-12hrs prior to exam water ingestion deep inspiration ask patient to perform the Valsalva maneuver

ask patient to perform the Valsalva maneuver

Which of the following is associated with hyperglycemia? diabetes mellitus islet cell tumor hyperinsulinism adenoma

diabetes mellitus

Which of the following serum levels would be unaffected by a benign obstruction of the biliary tree? ALP AFP GGTP conjugated bilirubin

AFP

Which of the following will help to differentiate HCC invasion of the PV from portal thrombosis on ultrasound examination? measure the PV diameter on inspiration and expiration measure the PV diameter on before and after a fatty meal cannot differentiate thrombus from tumor in the PV by ultrasound, requires CT exam apply power doppler to the PV

apply power doppler to the PV

Which of the following organs should be evaluated when looking for a tumor of the endocrine system? pancreas and kidneys salivary glands and adrenal glands liver, spleen, and pancreas pancreas and adrenal glands

pancreas and adrenal glands

A low albumin/globulin ratio usually indicates: cirrhosis impacted stone at the GB neck partial obstruction of the ampulla of Vater pancreatitis

cirrhosis

While scanning the liver, you identify a small focal area of intrahepatic ductal dilatation in the right lobe of the liver. The CBD measures 5mm in diameter and the GB appears normal. The liver demonstrates mild fatty infiltration and the pancreas and kidneys appear within normal limits. Which of the following correctly describes the lab findings that correlate with these findings? increased LFTs, normal direct bilirubin increased LFTs, increased bilirubin increased direct bilirubin, normal LFTs increased indirect bilirubin, increased LFTs

increased LFTs, normal direct bilirubin

All of the following are reasons for a patient to be NPO prior to an abdominal ultrasound EXCEPT: allow GB to fill with bile for better visualization decrease peristalsis in GI tract decrease blood sugar for better pancreas visualization decrease gas in GI tract

decrease blood sugar for better pancreas visualization

Which of the following is a contraindication for a liver transplant in a patient with HCC? more than 1 HCC tumor a single primary tumor >5cm more than 2 HCC tumors the presence of a tumor in the caudate lobe

contraindications include: a single primary tumor >5cm more than 3 HCC tumors metastatic disease

Which of the following describes a technique that can be used to locate a collapsed GB in a patient with chronic cholecystitis? locate the RPV and the MLF, trace the fissure to the GB neck have the patient perform the valsalva maneuver to force bile into the GB for improved visualization locate the umbilical vein and trace it to the Lig Teres to locate the GB neck just medial to the prox ligamentum use color Doppler to identify the associated hypervascularity seen with wall inflammation

locate the RPV and the MLF, trace the fissure to the GB neck

Several simple cysts are identified in the liver of a 38 year old male patient. What structures in the abdomen should also be evaluated for related findings? kidneys and thyroid abdominal AO and renal arteries kidneys and pancreas kidneys, pancreas, and ovaries

kidneys and pancreas

Which of the following ultrasound exams requires the patient to be NPO for accurate results? RUQ ultrasound for possible hematoma abdominal ultrasound for possible rectus sheath hematoma RUQ ultrasound for possible cholecystitis abdominal ultrasound for possible Crohn disease

RUQ ultrasound for possible cholecystitis

Acetic acid injection, ethanol injection, and radiofrequency ablation are techniques used to treat? varicosities polycystic liver disease HCC PHTN

HCC

All of the following correctly describe AFP, EXCEPT: liver metastasis causes the most significant increase in AFP levels normally only trace amounts are identified in adults increased levels are associated with liver cancer in adults and children it is substance produced by the fetal liver and yolk sac

the most significant increase in AFP levels is seen with HCC NOT LIVER METASTASIS

A 60 year old male presents for an abdominal ultrasound for recurrent epigastric pain. The patient tells you this is the 4th time he has been hospitalized for pancreatitis and the medications are just not working. What is the expected appearance of his pancreas on ultrasound? increased size with decreased echogenicity enlarged and edematous with a hyperechoic appearance atrophied with calcifications in the parenchyma atrophied with multiple cysts and calcifications consuming the parenchyma

atrophied with calcifications in the parenchyma

All of the following signs/symptoms are associated with the pathology demonstrated, EXCEPT Murphy sign increased WBC Homan sign fever

Homan sign - when the foot is quickly dorsiflexed and causes calf pain

What is an absolute contraindication for ethanol ablation of a liver nodule? nodule location in the central liver patient allergic to injectate nodule location in the periphery of the liver diabetes mellitus

patient allergic to injectate

Which of the following will cause a moderate increased in AFP values in an adult? adenoma glycogen storage disease HCC hepatoblastoma

HCC

Which probe position is used to demonstrate all three HVs entering the IVC? oblique subcostal approach angled superior toward the right shoulder sagittal subcostal position just to the left of midline oblique intercostal approach superior toward the left shoulder sagittal subcostal position just to the right of midline

oblique subcostal approach angled superior toward the right shoulder

In case of acute pancreatitis, which enzyme level increases first? trypsin amylase ALP lipase

amylase

The primary indication for a liver transplant in an adult is ___ and in children ___ is the most common indication. cirrhosis, Hep C cirrhosis, biliary atresia Hep C, cirrhosis biliary atresia, Hep C

cirrhosis, biliary atresia

ALP is normally produced by all of the following, EXCEPT: placenta liver tissue growing bones pancreas tissue

pancreas tissue ALP is found in the liver, bones, and placenta

Which of the following can be found on urinalysis of a patient with choledocholithiasis? AFP ALP unconjugated bilirubin conjugated bilirubin

conjugated bilirubin

Alcoholic fatty liver disease demonstrates what difference in lab values from nonalcoholic causes? alcoholic fatty liver disease demonstrates a much greater increase in LFT levels with an AST/ALT ratio >2 alcoholic fatty liver disease demonstrates a much smaller increase in LFT levels with an AST/ALT ratio < 1 alcoholic fatty liver disease has no effect on the AST level, but the ALT level is markedly increased alcoholic fatty liver disease demonstrates much greater increase in AFP levels

alcoholic fatty liver disease demonstrates a much greater increase in LFT levels with an AST/ALT ratio >2

Elevated GGTP and ALP indicates ___. Elevated GGTP and ALT indicates ___. hepatocellular disease, biliary obstruction hepatic carcinoma, hepatic adenoma biliary obstruction, hepatocellular disease cirrhosis, hepatitis

GGTP + ALP = biliary obstruction GGTP + ALT = hepatocellular disease

Which of the following lab values will increase with mucinous cystadenocarcinoma of the pancreas? alanine aminotransferase hematocrit carcinoembryonic antigen AFP

carcinoembryonic antigen

Which of the following is the most likely cause for an increase in AFP levels in a 7 month old boy? hepatoblastoma neuroblastoma pheochromocytoma nephroblastoma

hepatoblastoma

A 56 year old male presents with a 4 year history of cirrhosis. When performing the ultrasound exam on this patient, the size of which the following structures should be assessed to evaluate the effects of cirrhosis? PV, HV, and HA caudate lobe and HA left lobe and caudate lobe right lobe, PV, and caudate lobe

right lobe, PV, and caudate lobe

A patient presents for an abdominal ultrasound due to abdominal pain and bloating. The script for their exam read " R/O cholangiocarcinoma." What structure should you closely evaluate to answer the question? gallbladder biliary tree spleen adrenals

biliary tree

A patient presents for an abdominal sonogram due to a history of esophageal varices. What structure(s) should be closely evaluated for related findings? pylorus splenic artery renal arteries portal system

portal system

What lab values would be elevated in this patient? albumin and AFP ALP and PT unconjugated bilirubin and PT GGTP and creatinine

ALP and PT ALP, GGTP, PT and conjugated bilirubin and increased with extrahepatic ductal obstruction

A patient presents for an abdominal ultrasound with an order that states "R/O pancreatic endocrine tumor." Which of the following pancreatic tumors can be described as an endocrine tumor? cystadenocarcinoma oncocytoma pseudocyst gastrinoma

gastrinoma

A patient is referred for an abdominal ultrasound due to an abnormal CT scan. Refer to the image to determine where will you find the mass marked with #3? right anterior superior segment right posterior superior segment caudate lobe left medial superior segment

left medial superior segment

Which of the following blood tests will aid in diagnosis of a hydatid cyst in the liver? albumin/protein ratio and aldosterone assay ratio of conjugated bilirubin to unconjugated bilirubin indirect hemagglutination test and the enzyme-linked immunosorbent assay (ELISA) serum lipase and amylase

indirect hemagglutination test and the enzyme-linked immunosorbent assay (ELISA) Casoni test (similar to PPD test) can also be administered to assess for hydatid disease

Which of the following will typically demonstrate normal values on liver function tests? adenoma fatty liver HCC hepatoblastoma

adenoma

A patient's chart indicates they have a history of cavernous transformation. Where does this abnormality form? pancreatic tail porta hepatis Morrison pouch gallbladder fossa

porta hepatis

Which of the following is not an expected clinical symptom of an abscess? leukocytosis fever pain anemia

anemia

A patient presents with mildly increased levels of ALT and significantly increased levels of AST. Which of the following is an expected finding on the ultrasound exam? cirrhosis Mirizzi syndrome acute viral hepatitis choledocholithiasis

cirrhosis

Which of the following pancreatic abnormalities are associated with an increase in amylase and lipase levels in the blood? chronic pancreatitis and pseudocyst pseudocyst and adenoma pseudocyst, acute and chronic pancreatitis acute pancreatitis and pseudocyst

acute pancreatitis and pseudocyst

Which of the following statements correctly describes the findings on the image? the calipers are improperly placed inside the vessel walls and should be repositioned to measure the distance from outer wall to outer wall for an accurate measurement the PV is measured at the incorrect location along the course of the vessel, which causes the false appearance of enlargement the PV is measured correctly and demonstrates normal portal venous anatomy the PV is measured correctly and demonstrates possible PHTN

the PV is measured correctly and demonstrates possible PHTN

What lab value increases with gallbladder cancer, cholecystitis or prolonged biliary obstruction? AFP CA-125 LDH PT

What type of hepatic abscess causes a fever and leukopenia? fungal amebic pyogenic echinococcal

fungal

Which line indicates the correct AP measurement of the liver cyst? green purple orange blue

orange

Increased serum level of __ usually provide the first indication of an extrahepatic biliary obstruction. indirect bilirubin ALP aldosterone direct bilirubin

ALP

A patient presents for an abdominal US exam with a history of a recent single episode of significant indigestion. The lab results demonstrate increased levels of AST and normal levels or ALT, ALP and bilirubin. These clinical findings are most consistent with: chronic Hep C myocardial infarction schistosomiasis biliary stasis with a partial ductal obstruction due to Klatskin tumor

myocardial infarction ( increase AST with normal ALT )

Which of the following will cause an increase in AFP values in pediatric patients? FNH glycogen storage disease polycystic liver disease hepatoblastoma

hepatoblastoma

Which of the following Doppler parameters is most commonly used when evaluating the common hepatic artery in patient with a liver transplant? S/D ratio PSV pulsatility index resistive index

resistive index

Which line indicates the correct length measurement of the liver cyst? orange green blue purple

blue

What lab test is used to evaluate the exocrine function of a pancreas transplant? hematocrit levels glomerular filtration rate amylase levels glucose levels

amylase levels

ALT levels are: decreased with hepatitis, cirrhosis, liver tumors, biliary obstruction and Reye syndrome the most sensitive indicator for alcoholism used to evaluate the degree of jaundice and monitor hepatitis and cirrhosis the primary indicator for HCC

used to evaluate the degree of jaundice and monitor hepatitis and cirrhosis

Which of the following will lead to increased levels of indirect bilirubin in the blood? pancreatic adenocarcinoma fatty liver cirrhosis cholangitis

cirrhosis

serum amylase will be increased with all of the following, EXCEPT: parathyroid adenoma tumor of the submandibular gland acute pancreatitis use of oral contraceptives

parathyroid adenoma

Sulfur colloid imaging is: used to evaluate autosomal polycystic liver disease used to evaluate suspected FNH a type of contrast used in MR imaging a type of contrast used in CT imaging

used to evaluate suspected FNH

A 28 year old male presents for an abdominal ultrasound exam. The chart states he has elevated urine copper levels and Kayser-Fleischer rings noted on physical exam. What organ should be closely evaluated for findings related to the clinical findings? kidneys liver gallbladder bladder

liver

What lab values will be monitored in patients undergoing treatment for primary liver cancer? ALT ALP AFP bilirubin

AFP

Which of the following lab values would be elevated with biliary obstruction due to a HCC, but not with a biliary obstruction due to choledocholithiasis? GGTP conjugated bilirubin AFP ALP

AFP

Before performing a liver transplant evaluation, the Sonographer must review the surgical history to determine: if the transplant was full or partial the location of all sites of vascular anastomosis if the transplant has a piggyback or interposition anastomosis more than one of the above

more than one of the above

Dark urine and pale stool are indications of: RCC hyperbilirubinemia diverticulitis ulcerative colitis

hyperbilirubinemia

A patient presents for a RUQ ultrasound due to a positive Casoni skin test. What are you looking for on the exam? cirrhosis schistosomiasis metastasis in the liver hydatid cyst

hydatid cyst

Which of the following liver disorders will result in increased levels of iron stored in the liver? glycogen storage disease hemochromatosis Wilson disease amyloid disease

hemochromatosis

This image is the first sagittal image of an abdominal US exam you are performing. What should you be sure to do during the rest of the exam for this patient? evaluate the abdomen for fluid collections and/or active bleeding evaluate the organs for parasitic infection evaluate the organs for carcinoma evaluate the AO for thrombus accumulation and source of embolus

evaluate the organs for carcinoma portal lymphadenopathy is present

Which of the following correctly describes the method used to measure the wall thickness of the gallbladder? with the ultrasound beam as perpendicular to the gallbladder wall as possible, measure the AP thickness of the posterior wall with the ultrasound beam as parallel to the gallbladder wall as possible, measure the AP thickness of the anterior wall with the ultrasound beam as perpendicular to the gallbladder wall as possible, measure the AP thickness of the anterior wall with the ultrasound beam as parallel to the gallbladder wall as possible, measure the AP thickness of the posterior wall

with the ultrasound beam as perpendicular to the gallbladder wall as possible, measure the AP thickness of the anterior wall

Steatorrhea is a clinical finding with: hyperparathyroidism or parathyroid adenoma aortic or splenic aneurysms splenic or hepatic hemartomas pancreatitis or celiac disease

steatorrhea ( excess fecal fat ) is seen with pancreatitis or celiac disease

What lab test is used to evaluate the endocrine function of a pancreas transplant? amylase hematocrit glucose anodal trypsinogen

glucose

A 55 year old male presents with a history of Budd-Chiari syndrome. What vessels should be evaluated with Doppler on this exam? HVs HAs AO RVs

HVs

___ is a hemolytic disorder that causes increased indirect bilirubin levels in the blood. acute hepatitis Budd Chiari Kaposi sarcoma anemia

anemia

A patient is referred for an abdominal ultrasound due to an abnormal CT scan. The report is not available yet but the study is in the PACS system. Based on this single CT image, where will you scan to evaluate an abnormality identified on the CT exam? anterolateral left kidney right renal hilum anterolateral right kidney right lower quadrant

anterolateral right kidney

The liver measurement normally used to assess liver size is: measured from the TRV view at the midclavicular plane the medial to lateral dimension the superior inferior dimension overall volume 9 L x W x H x 0.5 )

the superior inferior dimension

Clinical #1 Flashcards

(105 cards)