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ARDMS ABD REVIEW > Pathology #2 > Flashcards

Pathology #2 Flashcards

1
Q

Based in the images, where is the obstruction?

MPV thrombosis with dilated portal branches in the liver
distal CBD
distal hepatic duct
cystic duct

A

distal CBD

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2
Q

Which of the following biliary conditions is associated with the formation of Rokitansky-Aschoff sinuses?

emphysematous cholecystitis
adenomyomatosis
pneumobilia
choledochal cyst

A

adenomyomatosis

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3
Q

Which of the following correctly describes the abnormal response seen on an ultrasound exam when a fatty meal is given to a patient with suspected biliary obstruction?

if a biliary obstruction is present, the bile duct diameter will increase immediately after the meal

the cystic duct dilates to allow for a detailed lumen evaluation for a possible stone

if a biliary obstruction is present, the bile duct diameter will decrease immediately after the meal

if a biliary obstruction is present, the bile duct diameter will remain unchanged immediately after the meal

A

if a biliary obstruction is present, the bile duct diameter will increase immediately after the meal

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4
Q

A patient presents for an abdominal US to further evaluate findings identified on a CT exam. The CT report indicates numerous cystic structures throughout the liver that communicate with the biliary tree. Which of the following could be used to describe the expected US diagnosis?

Wilson disease
polycystic liver disease
Caroli disease or choledochal cysts
choledochal cysts or polycystic liver disease

A

Caroli disease or choledochal cysts

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5
Q

A 56 year old male presents with a history of abdominal pain. Lab testing demonstrates isolated leukocytosis. He had a recent colonoscopy that demonstrated left sided ulcerative colitis. These ultrasound findings are most suggestive of:

sclerosing cholangitis
HIV cholangitis
cholangiocarcinoma
HA stenosis

A

sclerosing cholangitis

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6
Q

Primary GB carcinoma most commonly presents as:

focal wall mass without stones
enlarged GB surrounded by fluid
small GB with thickened walls
diffusely thickened GB wall with stones

A

diffusely thickened GB wall with stones

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7
Q

Numerous liver cysts with the central dot sign are most suggestive of:

hemorrhagic cysts
Caroli disease
Von Meyenburg complexes
polycystic liver disease

A

Caroli disease

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8
Q

This patient has an increased risk of developing:

porcelain GB
GB metastasis
Marfan syndrome
nephrolithiasis

A

porcelain GB

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9
Q

Which of the following can lead to a false positive diagnosis of stones in the biliary system?

rejection setting too high
decreased color Doppler gain
shadowing from surgical clip in porta hepatis
improperly decreased TGC settings

A

shadowing from surgical clip in porta hepatis

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10
Q

Chronic cholecystitis is commonly associated with:

GB carcinoma
polyps
pancreatic head mass
increased RBC count

A

GB carcinoma

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11
Q

Because there is a risk of cholangiocarcinoma with all cases of ___, surgical resection is recommended.

choledocholithiasis
mucocele of the GB
cholelithiasis
choledochal cysts

A

choledochal cysts

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12
Q

Diffuse or focal GB wall thickening may be seen with all of the following, EXCEPT:

adenomyomatosis
acute cholecystitis
carcinoma of the GB
courvoisier GB

A

courvoisier GB

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13
Q

An US demonstrates a non-shadowing, non-mobile, echogenic foci within the GB that most likely represents:

polyp
calculus
sludge ball
porcelain GB

A

polyp

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14
Q

Primary sclerosing cholangitis significantly increases the risk of developing:

hepatic lipoma formation
pancreatic carcinoma
klatskin tumor
cholangiocarcinoma

A

cholangiocarcinoma

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15
Q

RUQ pain, positive Murphy sign, and fever are common clinical signs of:

ascites
acute cholecystitis
adenomyomatosis
appendicitis

A

acute cholecystitis

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16
Q

Which of the following causes of diffuse dilatation of the intrahepatic biliary tree, without dilatation of the extrahepatic biliary tree?

Brenner tumor
mass at the valves of Heister
mass at the Ampulla of Vater
klatskin tumor

A

klatskin tumor

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17
Q

Which of the following biliary conditions is the most common cause of acute cholecystitis?

pancreatitis
mass in the duodenum
stone lodged in cystic duct
hepatitis

A

stone lodged in cystic duct

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18
Q

Distal cholangiocarcinoma is most commonly found ___ and a klatskin tumor is most commonly found ___.

in the left lobe, in the right lobe

near the dome of the liver, in the CBD near the porta hepatis

at the junction of the right and left hepatic ducts, outside the liver in the CBD

in the extrahepatic CBD near the porta hepatis, at the junction of the right and left hepatic ducts

A

in the extrahepatic CBD near the porta hepatis, at the junction of the right and left hepatic ducts

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19
Q

What is the most likely cause for the findings on the image?

hepatitis
chronic cholecystitis
acute cholecystitis
CHF

A

CHF

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20
Q

Which of the following abnormalities is associated with the production of milk of calcium bile?

cirrhosis
chronic cholecystitis
hepatoma
acute cholecystitis

A

chronic cholecystitis

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21
Q

Which of the following statements is true regarding the image displayed?

the MPV is significantly dilated, most likely due to PHTN

the GB is normal in appearance but the CBD is significantly dilated

the GB contains a stone and the MPV is significantly dilated

the GB wall demonstrates a solid mass and the CBD is significantly dilated

A

the GB wall demonstrates a solid mass and the CBD is significantly dilated

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22
Q

A 45 year old female patient presents with nausea and vomiting, RUQ pain, fever, and increased WBC. The GB is enlarged and filled with echogenic material that does not shadow or demonstrate fluid levels. These findings are most consistent with:

emphysematous cholecystitis
adenomyomatosis
empyema of the GB
porcelain GB

A

empyema of the GB

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23
Q

Which of the following is a congenital defect that causes bile stasis, impairs liver function and is associated with medullary sponge kidney and hepatic fibrosis?

choledocholithiasis
choledochal cyst
Caroli disease
Bouveret syndrome

A

Caroli disease

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24
Q

Which of the following is a true statement regarding the displayed image?

the GB is contracted with thickened walls and polyp formation caused by adenocarcinoma

the GB is contracted with thickened walls and polyp formation caused by adenomyomatosis

the GB is contracted and contains multiple shadowing stones within the lumen

the GB is contracted with thickened walls and pus formation caused by infection

A

the GB is contracted with thickened walls and polyp formation caused by adenomyomatosis

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25
Q

What is the most common cause of pneumobilia?

pancreatitis
GB perforation
ERCP
biliary duct stones

A

ERCP

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26
Q

An inflammation of the biliary tree common in HIV patients is called:

HIV cholangitis
primary sclerosing cholangitis
pneumobilia
bacterial cholangitis

A

HIV cholangitis

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27
Q

What two acoustic artifacts are associated with biliary hamartoma formation in the liver?

reverberation and shadowing
shadowing and speed propagation
enhancement and speed propagation
comet tail and twinkle

A

comet tail and twinkle

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28
Q

The most common finding with choledochal cysts is:

cyst formation at the ampulla of Vater
cystic dilatation of the CBD
cystic dilatation of multiple intrahepatic ducts
cyst formation on the fundus of the GB

A

cystic dilatation of the CBD

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29
Q

A cholecochal cyst is:

outpouching in the GB wall
complication of a portal thrombosis
associated with angiomyolipoma
focal dilatation of the biliary tree

A

focal dilatation of the biliary tree

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30
Q

Which of the following is associated with prolonged fasting?

pyloric stenosis
steatosis
splenosis
GB sludge

A

GB sludge

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31
Q

What biliary abnormality is a common finding in patients with hemolytic anemia?

cholelithiasis
adenomyomatosis
cholecystitis
gangrenous cholecystitis

A

cholelithiasis

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32
Q

Which of the following would present with no signs of jaundice?

mucocele of the GB
a stone at the ampulla of Vater
hepatitis
sphincter of Oddi dysfunction

A

mucocele of the GB

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33
Q

What is the most common cause of cholangitis?

adenomyomatosis
choledocholithiasis
klatskin tumor
AIDS

A

choledocholithiasis

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34
Q

Which of the following correctly describes how to differentiate cholangitis from cholangiocarcinoma?

cholangitis leads to dilated extrahepatic ducts while cholangiocarcinoma leads to dilated intrahepatic ducts

cholangitis is a focal disease process while cholangiocarcinoma causes diffuse mass formation

cholangitis leads to dilated intraheptic ducts while cholangiocarcinoma leads to dilated extraheptic ducts

cholangitis is a diffuse disease process while cholangiocarcinoma causes focal mass formation

A

cholangitis is a diffuse disease process while cholangiocarcinoma causes focal mass formation

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35
Q

A 64 year old patient presents with painless jaundice. The GB is over-distended with a biliary obstruction at the level of the ampulla of Vater. Which of the following best describes this condition?

Mirizzi syndrome
Courvoisier sign
hydropic GB
choledochal cyst

A

Courvoisier sign

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36
Q

While scanning the GB, you notice several echogenic foci within the mildly thickened wall that do not demonstrate reverberation artifact. These findings are most suggestive of:

adenomyomatosis
cholesterolosis
secondary GB carcinoma
chronic cholecystitis

A

cholesterolosis

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37
Q

A patient presents for a 2 month follow up for liver transplant. Lab tests indicate abnormal LFTs, increased bilirubin and jaundice. The US exam demonstrates a new focal dilatation of the bile duct at the porta hepatis with mildly dilated intrahepatic ducts just inside the liver. The pancreas is normal. These findings are most consistent with:

mass in the ampulla of Vater
Budd Chiari
biliary stricture
choledochal cyst

A

biliary stricture

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38
Q

If pneumobilia is suspected, visualization of what acoustic artifact would support that diagnosis?

posterior enhancement
slice thickness
range resolution
ringdown

A

ringdown

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39
Q

What term describes a GB that is filled with bile is isoechoic to the liver and is difficult to identify on ultrasound?

Charcot triad
Courvoisier GB
hepatization
Mirizzi syndrome

A

hepatization

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40
Q

Which of the following is the most likely cause for the findings on the image?

Kaposi sarcoma, intrahepatic obstruction
portal thrombosis at the porta hepatis
cystic duct obstruction
tumor of the ampulla of Vater

A

tumor at the ampulla of Vater

** GB is enlarged with internal debris with intrahepatic ductal dilatation = extrahepatic obstruction

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41
Q

Cholelithiasis without cholecystitis is most likely to be seen in a patient with:

a history of recent abdominal surgery
AIDS
a history of a prolonged low fat diet
sepsis

A

a history of a prolonged low fat diet

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42
Q

Which of the following describes how to differentiate tumefactive sludge from GB carcinoma?

use color Doppler over the area of interest
give the patient a fatty meal and rescan
turn off harmonic imaging
ask the patient to perform the Valsalva maneuver

A

use color Doppler over the area of interest

43
Q

A 66 year old female presents for an abdominal ultrasound due to bloating and pain following a recent cholecystectomy. The bile ducts demonstrate varied levels of increased echogenicity with dirty shadowing and ringdown artifact posterior to several segments. These findings are most consistent with:

cholangiocarcinoma
pneumobilia
choledocholithiasis
sclerosing cholangitis

A

pneumobilia

** dirty shadowing and ringdown artifact are associated with the presence of air/tissue interface

44
Q

The twinkle artifact is an expected finding in cases of:

MCDK
ADPKD
adenomyomatosis
renal carbuncle

A

adenomyomatosis

45
Q

Cholelithiasis without cholecystitis is a common finding in patients with ___, while cholecystitis without cholelithiasis is a common finding in patients ___.

CHF, with sepsis

on long-term total parenteral nutrition, on a consistently low fat diet

a consistently low fat diet, on long-term total parenteral nutrition

a consistently high diet, on a consistently low fat diet

A

a consistently low fat diet, on long-term total parenteral nutrition

46
Q

A patient presents for an abdominal ultrasound due to nausea and vomiting. While scanning the GB, the patient asks you to take a break due to the pain caused by the transducer pressure. How should you report this to the radiologist?

patient uncooperative, unable to efficiently perform the exam

positive Homan sign

positive Morrison sign

positive Murphy sign

A

positive Murphy sign

47
Q

A porcelain GB causes an increase in the patient’s risk for ___.

adenomyomatosis
choedocholithiasis
primary carcinoma
sclerosing cholangitis

A

primary carcinoma

48
Q

A patient presents for an abdominal ultrasound for pain. The chart holds a recent x-ray report that states there is a possible porcelain GB present. How will this abnormality appear on the ultrasound exam?

the GB wall will demonstrate varied levels of linear calcification

the GB will be hydropic with a thickened wall and an increased risk of rupture

there is a single large stone present with a thickened GB wall

the GB will be completely packed full of small stones

A

the GB wall will demonstrate varied levels of linear calcification

49
Q

A patient presents with a low grade fever, leukocytosis, nausea, diarrhea and LLQ pain. What is the most likely explanation for the findings on the image?

biliary stricture in the cystic duct
mass at the ampulla of Vater
primary sclerosing cholangitis
Caroli disease

A

primary sclerosing cholangitis

50
Q

The GB wall is asymmetrically thickened with hypervascularity and perfusion defects noted on color Doppler evaluation. Intraluminal membranes and sludge are also present. What is the most likely cause for these findings?

cholesterolosis
chronic cholecystitis
gangrenous cholecystitis
adenomyomatosis

A

gangrenous cholecystitis

51
Q

Which of the following is caused by infection or ischemia of the GB wall?

Hartmann pouch
adenomyomatosis
Bouveret syndrome
membranous gangrenous GB

A

membranous gangrenous GB

52
Q

All of the following terms can be used to describe the findings on the image, EXCEPT:

adenomyomatosis
strawberry GB
hyperplastic cholecystosis
cholesterolosis

A

adenomyomatosis

53
Q

A patient presents with RUQ pain after a recent endoscopy procedure. The findings on the image are most suggestive of:

retained surgical instruments
choledocholithiasis
surgical clips
pneumobilia

A

pneumobilia

54
Q

Which of the following statements regarding GB sludge is NOT true?

sludge can appear as varied layers of echogenic material in the GB lumen

tumefactive sludge can have a sonographic appearance similar to GB carcinoma

changing patient position and rescanning the GB ca differentiate sludge from artifact

GB sludge is always associated with wall thickening

A

GB sludge is always associated with wall thickening

55
Q

Which of the following biliary abnormalities would be an acute complication caused by a bacterial infection of the GB?

emphysematous cholecystitis
adenomyomatosis
porcelain GB
strawberry GB

A

emphysematous cholecystitis

56
Q

A patient presents with intermittent RUQ pain and nausea. No lab information was available at the time of the ultrasound exam. The findings on the image are most suggestive of:

empyema of the GB
GB mestastasis
primary GB carcinoma
tumefactive sludge

A

GB metastasis

** most commonly presents as an intraluminal mass without associated stones

57
Q

If gallstone impaction is suspected:

scan the patient in multiple positions to attempt to move the stone

place the patient in the LLD position and ask the patient to perform the Valsalva maneuver to attempt to move the stone

place the patient in the LLD position and tap the patient’s back between the scapulas with the base of your wrist to attempt to move the stone

ask the patient to stand during the exam and perform the Valsalva maneuver to attempt to move the stone

A

scan the patient in multiple positions to attempt to move the stone

58
Q

A patient with choledochal cysts has an increased risk of developing ___.

PHTN
cholangiocarcinoma
polycystic liver disease
biliary atresia

A

cholangiocarcinoma

59
Q

Which image demonstrates a GB with characteristics of adenomyomatosis?

A
60
Q

A 4 month old presents for an abdominal ultrasound following a recent Kasai procedure. Which of the following ultrasound findings would indicate the procedure was a success?

echogenic graft connecting the hepatic and portal venous systems in the liver with flow velocity greater than 40cm/s

normal liver echotexture with normal biliary duct diameter

echogenic mesh in the abdominal wall used to close an umbilical hernia

echogenic mesh in the abdominal wall used to close an inguinal hernia

A

normal liver echotexture with normal biliary duct diameter

61
Q

Which of the following describe how to differentiate adenomyomatosis of the GB from cholesterolosis of the GB?

the polyps in cholesterolosis do not exhibit the comet tail artifact but polyps with adenomyomatosis do

the polyps in adenomyomatosis do not exhibit the comet tail artifact but polyps with cholesterolosis do

adenomyomatosis is usually focal process and cholesterolosis is a diffuse process

adenomyomatosis is usually a diffuse process and cholesterolosis is a focal process

A

the polyps in cholesterolosis do not exhibit the comet tail artifact but polyps with adenomyomatosis do

62
Q

What structure is indicated by #3?

CBD
MPV
IVC
splenic vein

A

MPV

63
Q

An 85 year old patient presents with a history of epigastric pain. Lab values are normal. The exam demonstrates normal intrahepatic ducts and a 10mm CBD that appears patent. The pancreas appears normal. What is the most likely reason for the 10mm CBD?

the obstruction in the CBD must be due to biliary stricture which is hard to visualize sonographically

the patient most likely has PHTN which can cause ductal dilatation

the CBD normally dilates with age

cholangitis usually only affects the CBD and can lead to a focal extrahepatic dilatation

A

the CBD normally dilates with age

64
Q

Which of the following correctly describes how to differentiate a large gallstone ( >3cm ) from a porcelain GB?

a large gallstone and porcelain GB are not easily differentiated sonographically

the posterior wall of the GB can be evaluated in patients with porcelain GB but not in patients with a large stone

a gallstone will demonstrate significant posterior shadowing but there is no shadowing associated with the wall calcification seen with a porcelain GB

the gallstone can be located in any part of the GB while porcelain calcification only affects the GB fundus

A

the posterior wall of the GB can be evaluated in patients with porcelain GB but not in patients with a large stone

65
Q

Acaculous cholecystitis is a common finding in all of the following, EXCEPT:

AIDS
a history of a prolonged low fat diet
sepsis
a history of recent abdominal surgery

A

a history of a prolonged low fat diet

66
Q

What structure is indicated by #1?

MPV
CBD
splenic vein
HA

A

CBD

67
Q

The bile duct diameter should be measured with the calipers placed from:

inner wall to outer wall
inner wall to inner wall
leading edge to leading edge
outer wall to outer wall

A

inner wall to inner wall

68
Q

Acute cholecystitis can lead to a prominent ___ and its branches with color Doppler evaluation of the thickened GB wall.

LHA
proper HA
common HA
cystic artery

A

cystic artery

69
Q

An impacted stone in the GB neck increases the risk of developing:

cholecystitis and gangrene
stones and dilatation in the intrahepatic ducts
stones and dilatation in the extrahepatic ducts
adenomyomatosis and polyp formation

A

cholecystitis and gangrene

70
Q

A 6 year old female presents with recent weight loss and mild jaundice. Lab values demonstrate normal WBC levels, but increased levels of direct bilirubin, ALP and PT. The GB demonstrates a small wall mass that is isoechoic to the wall tissues. The wall measures 4.5mm in maximum thickness. Multiple stones are present within the lumen. Which of the following best describes the findings on the image?

acute cholecystitis, polyp formation and cholethiasis
primary GB carcinoma and cholelithiasis
acute cholecystitis and cholelithiasis
adenomyomatosis

A

primary GB carcinoma and cholelithiasis

71
Q

A patient has a history of adenomyomatosis of the GB. What acoustic artifact is expected to be present on the US images of the GB?

volume averagig
mirror image
side lobe
comet tail

A

comet tail

72
Q

Mirizzi syndrome is caused by obstruction of the ___, while Courvoisier GB is related to obstruction of the ___.

cystic duct, distal CBD
intrahepatic CBD, extrahepatic CBD
proximal CBD, distal CBD
distal CBD, cystic duct

A

cystic duct, distal CBD

73
Q

The WES sign indicates a diagnosis of:

cholelithiasis
porcelain GB
GB adenocarcinoma
tumefactive sludge

A

cholelithiasis

74
Q

What biliary anomaly is suspected if jaundice persists more than 14 days after birth?

choledochal cyst
biliary atresia
agenesis of the GB
ectopic GB

A

biliary atresia

75
Q

Which of the following are types of hyperplastic cholecystosis?

adenomyomatosis and cholesterolosis
perforation and pericholecystic fluid
cholelithiasis and choledocholithiasis
sludge and tumefactive sludge

A

adenomyomatosis and cholesterolosis

76
Q

An otherwise asymptomatic patient presents for an abdomen ultrasound due to elevated LFTs. The GB demonstrates thickened walls with an irregular internal contour. Several small echogenic foci are noted within the wall and each exhibits a comet tail artifact. Which of the following conditions is identified on this exam?

cholesterol polyps
emphysematous cholecystitis
chronic cholecystitis
adenomyomatosis

A

adenomyomatosis

77
Q

A patient presents with RUQ pain and nausea 1 week post-cholecystectomy. The findings on the image are most suggestive of:

pneumobilia
abscess formation in GB fossa
porcelain GB
biloma formation in GB fossa

A

abscess formation in GB fossa

** note the irregular mass in the fossa with echogenic foci, debris, and dirty shadowing consistent with pus formation and air pockets from the bacteria

78
Q

Which of the following statements best describes the findings on the image?

there is a polyp located on the posterior wall of the GB fundus

there is a polyp located on the inferior wall of the GB neck

there is a polyp located on the inferior wall of the GB fundus

the GB demonstrates a cholesterol polyp with the comet tail artifact

A

there is a polyp located on the inferior wall of the GB neck

79
Q

Which type of GB disease is more common in males and diabetic patients?

chronic cholecystitis
cholangitis
emphysematous cholecystitis
GB perforation

A

emphysematous cholecystitis

80
Q

Acute cholecystitis is associated with GB wall thickening ___. Cholangitis is associated with ductal wall thickening ___.

> 2mm, >3mm
3mm, >2mm
3mm, >5mm
6mm, >3mm

A

> 3mm, >2mm

81
Q

Which of the following is NOT true regarding milk of calcium bile?

lumen filled with highly echogenic material with shadowing

related to hyperfunction of the GB

layering of bile/calcium with change of patient position

also called limey bile

A

related to hyperfunction of the GB

82
Q

GB polyps measuring greater than ___ in diameter are highly suspicious for malignancy.

5mm
10mm
15mm
20mm

A

10mm

83
Q

A 6 month old Asian female presents with jaundice and fever. While scanning the liver, you note a 1cm anechoic, round dilatation of the extrahepatic CBD at the porta hepatis. Color Doppler does not demonstrate flow within the structure. Which of the following is the most likely diagnosis?

choledochal cyst
pneumobilia
cholangitis
pseudoaneurysm of the HA

A

choledochal cyst

84
Q

Tumefactive sludge can be found in:

renal pelvis
paracolic gutters
GB
gastric antrum

A

GB

85
Q

A new liver mass in a patient with sclerosing cholangitis should cause suspicion of:

the development of schistosomiasis
the development of cholangiocarcinoma
a peribiliary leak
PHTN

A

the development of cholangiocarcinoma

86
Q

Jaundice is a complication of:

steatosis and hemangiomas
ductal obstruction and RBC destruction
steatosis and polycystic liver disease
ductal obstruction and WBC destruction

A

ductal obstruction and RBC destruction

87
Q

Which of the following is a cause of parasitic cholangitis?

biliary ascariasis
ulcerative colitis
HIV infection
gram negative bacteria

A

biliary ascariasis

88
Q

Which of the following is associated with the findings on the image displayed?

adenocarcinoma formation in the pancreatic head
obstruction of the ampulla of Vater
Krukeberg tumor formation in the duodenum
more than one of the above

A

more than one of the above

89
Q

A non-infectious cause of acalculous cholecystitis is ___ and an infectious cause of acalculous cholecystitis is ___.

HIV, viscous bile
CHF, total parenteral nutrition
total parenteral nutrition, HIV
viscous bile, Mirizzi syndrome

A

total parenteral nutrition, HIV

90
Q

Which of the following is least likely to be associated with GB sludge?

cystic duct obstruction
elevated cholecystokinin levels
fasting
alcoholism

A

elevated cholecystokinin levels

91
Q

An infant is referred for an abdominal sonogram due to prolonged jaundice after birth. A small triangular echogenic area is identified at the portal vein bifurcation, but no definite extrahepatic duct is noted. The GB is very small and abnormally shaped. These findings are most suggestive of:

biliary atresia
Caroli disease
biliary ascariasis
choledochal cyst

A

biliary atresia

92
Q

A choledochocele is:

a collection of bile that forms around a perforated GB

a cyst of the intraduodenal portion of the duct

a type of cyst that forms at the terminal ducts in the biliary tree

an intrahepatic collection of bile that forms around a major branch of the biliary tree

A

a cyst of the intraduodenal portion of the duct

93
Q

What structure is indicated by #2?

CBD
MPV
HA
splenic vein

A

HA

94
Q

A 35 year old male patient presents for a RUQ ultrasound due to pain, increased ALP and conjugated bilirubin. You identify dilated intrahepatic ducts in both lobes of the liver, while CBD and GB appear within normal limits. Which of the following describes the cause of these findings?

stone in the right hepatic duct
stone in the common hepatic duct
stone in the left hepatic duct
biliary atresia

A

stone in the common hepatic duct

** dilated intrahepatic ducts = obstruction at the CHD

95
Q

Tumefactive sludge would demonstrate a sonographic appearance similar to all of the following, EXCEPT:

membranous gangrenous cholecystitis
secondary GB carcinoma
benign polyp
primary GB carcinoma

A

membranous gangrenous cholecystitis

96
Q

The complications caused by a large gallstone in the duodenum obstructing the gastric outlet are collectively referred to as:

Courvoisier syndrome
Mirizzi syndrome
Marfan syndrome
Bouveret syndrome

A

Bouveret syndrome = large gallstone in the duodenum that causes an obstruction of the gastric outlet

97
Q

A long standing, partial obstruction of the cystic duct will most likely lead to which of the following?

mucocele of the GB
porcelain GB
septated GB
Hartmann pouch

A

mucocele of the GB

98
Q

Obstruction of the CBD by a pancreatic head mass will lead to:

contracted, small GB with normal biliary tree
dilated GB and biliary tree
contracted, small GB with dilated biliary tree
all of the above are potential findings

A

dilated GB and biliary tree

99
Q

A biloma is:

associated with malignancy of the biliary tree
a possible complication of left renal surgery
a collection of bile in the peritoneal cavity
a congenital malformation of the biliary tree

A

a collection of bile in the peritoneal cavity

100
Q

If the common hepatic duct is obstructed, how will this affect the other biliary structures?

contracted GB and dilated intrahepatic ducts
dilated GB and dilated intrahepatic ducts
dilated extrahepatic ducts
contracted GB and dilated extrahepatic and intrahepatic ducts

A

contracted GB and dilated intrahepatic ducts

101
Q

A patient presents for an abdomen ultrasound with RUQ pain, nausea, fever, and leukocytosis. An abnormal enlarged GB demonstrates thickened walls at 1.2cm. An anterior segment of the wall is echogenic and ringdown artifact and dirty shadowing are present posterior to this area. Which of the following conditions is identified on this exam?

emphysematous cholecystitis
adenomyomatosis
chronic cholecystitis
cholesterol polyps

A

emphysematous cholecystitis

102
Q

Bacterial cholangitis is nearly always seen with:

HIV cholangitis
ductal obstruction by a stone or tumor
ulcerative colitis
biliary ascariasis

A

ductal obstruction by a stone or tumor

103
Q

Which of the following GB abnormalities have a very similar appearance on ultrasound evaluation and clinical history is necessary for differentiation?

chronic cholecystitis and Courvoisier GB
porcelain GB and tumefactive sludge
acalculous cholecystitis and adenomyomatosis
hemobilia and sludge

A

hemobilia and sludge

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