midterm test Flashcards
1
Q
- 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 and orders and ultrasound of the gallbladder to rule out which of the following?
A
gallbladder carcnioma
2
Q
- 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
gallbladder carcinoma
3
Q
- You have a patient scheduled for a gallbladder sonogram. What preparation is required?
A
patient should fast for 8-12 hours
4
Q
- An area within the spleen that has become necrotic because of a lack of oxygen is referred to as
A
Splenic infarct
5
Q
- The splenic vein drains into what vein?
A
SMV
6
Q
- Focal tenderness over the gallbladder with probe pressure describes:
A
Murphy’s sign
7
Q
- 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
8
Q
- Courvoisier’s gallbladder can be associated with which of the following:
A
GALLBLADDER CARCINOMA
9
Q
- While trying to identify the gallbladder, you belive that you see a gallbladder filled with stones demostrating the WES sign. What landmark do you use to positively identify the gallbladder?
A
main lobar fissure
10
Q
- 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
emphysematous cholecystits
11
Q
- A patient is referred from the emergency room to rule out acute cholecystitis. You think the common bile duct is dilated. What it the normal diameter for the biliary duct?
A
6mm
12
Q
- What is the most common cause of acute cholecystitis
A
? Calculus obstruction of the gallbladder neck or cystic duct
13
Q
- 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
A
D. all of the above
14
Q
- 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 liekly represents which of the following?
A
Adenomyomatosis
15
Q
- Hartmann pouch involves which part of the gallbladder
A
neck
16
Q
- A 51 year old man undergoes an ultrasound of the RUQ. Pertinant history includes multiple previous ultrasound examinations that document a small liver that is difficult to penetrate. Liver enzymes levels (AST, ALT, GGT, PTT, & albumin) are elevated. The patient is very thin, with a slighlty protruding abdomen. The liver remains small and difficult to penetrate, with poorly documented hepatic vasculature. No specific masses are noted. Free fluid is noted within Morrison’s pouch and the right subphrenic space. The anterior border of the liver is noted to have scalloped appearance. Which of the following is the most likely diagnosis?
A
cirrhossis
17
Q
- Which hepatic mass is closely associated with oral contraceptive use?
A
adenoma
18
Q
- Clinical findings of fatty infiltrate of the liver include:
A
elevated liver function test
19
Q
- A 50 year old African American immigrant worker with RUQ pain and weight loss is seen for ultrasound. The patient states that he worked in the fields growing and harvesting a variety of grains for 30 years. Laboratory results an elevated sreum alpha-fetoprotein level. Ultrasound examination shows a 4 cm heterogeneous lesion in the liver and a small amount of ascites. This would suggest which of the following?
A
hepatocellular carcinoma
20
Q
- A solitary, anechoic lesion is identifed in the right lobe of a 50 year old woman. The lesion is 2.5 cm with smooth walls and acoustic enhancement. The patient has mild epigastric pain, especially with spicy foods, and the remainder of the ultrasound examination is unremarkable. The anechoic lesion most likely represents which of the following?
A
liver cyst
21
Q
- Normal flow toward the liver in the portal vein is termed:
A
hepatopetal
22
Q
- A 32 year old obese woman is seen for right upper quadrant ultrasound to rule out gallstones. The sonographer’s inquiry into the patient’s symptoms reveal fatty food intolerance. Ultrasound examination of the abdomen reveals cholelithiasis and a 1.5 cm echogenic lesion in the liver. The most likely diagnosis for the lesion is
A
hemangioma
23
Q
- A 45-year old man with a history of cirrhosis is seen for ultrasound examintation of the abdomen. The sonographer idnetifies a 6 cm complex mass in the liver. This would be suspicious for which of the following tumors?
A
hepatocellular carcinoma
24
Q
- A 70-year old woman is seen for malaise and wasting. The clinician orders an abdominal ultrasound because of the patient’s history of colon cancer and elevated liver function tests. The sonographer notes multiple hyperechoic lesions within the liver and hepatomegaly. This is suggestive of:
A
metastatic disease
25
25. A 58 year old woman with epigastric pain with eating is seen for an abdominal ultrasound to rule out gallstones. The sonographer identifies normal-appearing gallbladder, liver, pancreas, and spleen. The sonographer also documents a dilation of the aorta, which measures 6 cm at its greatest diameter. This would be consistent with which of the following?
aortic aneurysm
26
26. Occlusion of the hepatic veins describes
Budd Chairi syndrome
27
27. A 40 year old man with a history of Marfan syndrome is seen with intense chest pain in the emergency department. Which of the following diagnoses should should be the primary consideration?
aortic dissection
28
28. You are performing a Doppler study of the portal vein and detect that the flow direction in the main portal vein is the same as the hepatic artery. What does this indicate?
NORMAL
29
29. Enlargement of the IVC, with subsequent enlargement of the hepatic veins, is seen in cases of:
right sided heart failure
30
30. A 55 year old man is seen for a routine physical examination. During the examination, the physicians feels a pulsatile mass at the level of the umbilicus. An ultrasound is ordered for which of the following indications?
to rule out AAA
31
what is the biggest risk factor for rupture of an AAA
Aneurysm size
32
32. You are scanning a patient with increased pancreatic enzymes and white blood cell count. Which of the following conditions is most commonly associated with these lab findings?
acute pancreatitis
33
33. You are scanning a 52 year old male with a history of alcohol abuse. Ultrasound findings include a hyperechoic mass in the head of the pancreas, dilation of the pancreatic and common bile duct, diffuse calcification within the pancreas. Which of the following conditions is most likely present?
chronic pancreatitis
34
34. Which of the following is a risk factor for the development of pancreatic cancer?
chronic pancreatitis
35
35. The pancreatic tail is outlined posteriorly by what vascular structure?
splenic vein
36
36. What is the most common cause of acute pancreatitis?
obstruction of the pancreatic duct by biliary calculi
37
37. Which laboratory value is more specific for acute pancreatitis?
Lipase
38
38. The most common location of adenocarcinoma of the pancreas is within the
head
39
39. A thin patient has been referred for ultrasound evaluation of the pancreas. Which of the following transducers would be best for this examination?
5.0MHZ curved linear array
40
40. A 25 year old female patient presents to the ultrasound department for a complete abdominal ultrasound. She complains of right lower quadrant pain and nausea. The right upper abdomen appears normal. A small mass is noted in the area of the splenic hilum. This mass appears isoechoic to the spleen. What does this most likely represent?
accessory spleen
41
41. A complex cyst that results from the parasitic infestation of the spleen by a tapeworm is the:
hydatid cyst
42
42. A 48 year old male patient with a history of severe, sudden onset of left upper quadrant pain without trauma presents to the ultrasound department for a sonogram of the spleen. You visualize a wedge-shaped, hypoechoic area within the spleen. This most likely represents a:
splenic infarct
43
44. A 35 year old male patient presents to the ultrasound department for an abdominal ultrasound with a history of abdominal pain and histoplasmosis. What are you more likely to identify within the spleen
multiple granuloma
44
45. A rare malignant tumor of the spleen that consists of blood vessels is a/an:
: angioscaroma
45
46. A 14 year old male patient presents to the ultrasound department after falling from his bicycle. An abdominal ultrasound reveals a complex appearing mass within the spleen. This most likely represents:
splenic hematoma
46
47. You are performing an ultrasound study on a patient with malignant melanoma. Your ultrasound findings reveal multiple hyperechoic masses within the spleen. This most likely represents:
metastatsis
47
48. Where is the most common location of an accessory spleen?
splenic hilum
48
49. Diffuse involvement of lymphoma or leukemia of the spleen will often lead to:
splenomegaly
49
50. The most common cause of splenomegaly is
portal hypertension
50
51. The most common benign neoplasm of the spleen include all of the following except:
infarctions
51
52. Which of the following is a symptom of ruptured aneurysm?
nausea and vomiting
52
53. The most common tumor to invade the IVC is:
RCC
53
54. Joe, a sheep farmer, arrives at the hospital with right upper quadrant pain, fever, and elevated white blood cell count. He states the 3 months ago he was kicked in the ribs. An irregular mass with low-level echoes is found on the ultrasound. What is the differential diagnosis?
Echinococcal cyst
54
55. This image was obtained on a 72 year old woman with RUQ pain. The patient presents with elevated LFT’s and nausea and weight loss.
simple liver cyst
55
56. This image was obtained on 85 year old female with jaundice, weight loss, and palpable RUQ mass. What is the best diagnosis
adenocarcinoma of the gallbladder
56
57. The splenic artery originates at the:
celiac trunk
57
58. An African American male present to the u/s department for a RUQ ultrasound for pain. He has a history of smoking and diabetes. What is the best diagnosis?
adenocarcinoma
58
59. A 23 year old male report to the ultrasound department for LUQ ultrasound with a history of mononucleosis. What is the best diagnosis?
splenomegaly
59
60. This 56 year old female presents to the ultrasound department with elevated liver enzymes and a history of lung cancer. How would you best describe this image?
Multiple hypoechoic masses throughout the hyperechoic liver
60
61. This patients presents with RUQ pain, tender hepatomegaly, fever, nausea, and vomiting and weight loss. He recently traveled to a foreign country. He also has a history of abdominal aortic aneurysm. What is the best diagnosis?
abscess
61
62. Ascites is the accumulation of fluid in which cavity?
peritoneal cavity
62
63. A permanent localized dilation of an artery with an increase in diameter of greater than 1.5 times it’s normal diameter is termed:
aneurysm
63
64. You are performing an ultrasound exam to rule out cholelithiasis. You identify a small echogenic foci in the posterior aspect of the gallbladder fundus. How can you determine if the foci represents a polyp or a stone?
Shadowing is not present with polyps but is present with stones
64
65. This benign liver tumor is located near the free edge of the liver, is solitary, well circumscribed, and is a nonencapsulated multinodular mass:
focal nodular hyperplasia
