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ARDMS ABD REVIEW > Pathology #3 > Flashcards

Pathology #3 Flashcards

1
Q

While scanning the liver in patient with chronic cirrhosis, you notice a tubular vessel connecting to the LPV and exiting the liver coursing inferiorly. Flow within the vessel is very low velocity, continuous and moving in a caudal direction. Which of the following explains the ultrasound findings?

a dilated coronary vein is present which is a common complication of cirrhosis

the ductus venosus is dilated with antegrade flow which is a common complication of cirrhosis

a dilated umbilical vein is present which is a common complication of cirrhosis

a dilated SMV is present with flow reversal which is a common complication of cirrhosis

A

a dilated umbilical vein is present which is a common complication of cirrhosis

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2
Q

While scanning the liver in a patient with chronic cirrhosis, you notice a tubular vessel connecting to the splenic vein just prior to its confluence with the SMV. Flow within the vessel is very low velocity, continuous and moving in a cephalic direction. Which of the following explains the ultrasound findings?

a dilated SMV is present with flow reversal which is a common complication or cirrhosis

a dilated coronary vein is present which is a common complication of cirrhosis

a dilated umbilical vein is present which is a common complication of cirrhosis

the ductus venosus is dilated with antegrade flow which is a common complication of cirrhosis

A

a dilated coronary vein is present which is a common complication of cirrhosis

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3
Q

___ abscesses are most commonly found in countries outside the US. ___ abscesses are most commonly seen in immunosuppressed patients.

pyogenic, amebic
fungal, amebic
amebic, fungal
fungal, pyogenic

A

amebic, fungal

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4
Q

Which of the following describes a non-infectious cause for hepatitis?

anabolic steroids
fungus
bacteria
virus

A

anabolic steroids

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5
Q

What type of liver infection/abscess is commonly associated with immunocompromised patients?

schistosomiasis
amebic
pyogenic
candidiasis

A

candidiasis

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6
Q

The diameter of the ___ will be relatively unaffected by hepatic congestion.

MPV
RHV
LHV
HA

A

HA

**HA diameter is relatively unaffected but the resistance to flow can increase

HVs and PV will dilate

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7
Q

What condition is associated with prominent portal walls?

hemangioma
fatty infiltration
acute viral hepatitis
cirrhosis

A

acute viral hepatitis

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8
Q

Which of the following statements is true regarding the Doppler evaluation of the liver vasculature displayed?

the HA and PV are demonstrated with normal flow directions

the HA is hepatopetal and the PV is hepatofugal

the HA is hepatofugal and the PV is hepatopetal

the PV flow is normal but the HA demonstrates increased resistance

A

the HA is hepatopetal and the PV is hepatofugal

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9
Q

The most common finding with congestive hepatomegaly is:

IVC dilatation
liver atrophy
AAA
PV aneurysm

A

IVC dilatation

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10
Q

The hormone changes with pregnancy have been associated with the enlargement of what type of liver mass?

granuloma
hemangioma
schistosomiasis
hepatoma

A

hemangioma

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11
Q

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

the PV is of normal diameter but appears to be filled with thrombus related to chronic PHTN

the PV is at the top normal diameter at 17mm. the PV is considered abnormally dilated at a diameter 18mm or greater

the PV is abnormally dilated at 17mm and is filled with mildly echogenic thrombus

the PV is dilated at 17mm but does not demonstrate color Doppler signals due to the perpendicular incidence with the probe

A

the PV is abnormally dilated at 17mm and is filled with mildly echogenic thrombus

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12
Q

___ is the most common malignancy of the liver seen in a patient with AIDS. ___ is the most common infection of the liver seen in a patient with AIDS.

hepatocellular carcinoma, hepatitis
hepatoblastoma, candidiasis
metastasis, schistosomiasis
Kaposi sarcoma, pneumocystis carinii

A

Kaposi sarcoma, pneumocystis carinii

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13
Q

Which of the following are contraindications for a liver transplant?

HCC and hepatitis
cholangiocarcinoma and current alcohol/drug abuse
autosomal recessive polycystic disease and biliary hamartomas
hep C and cirrhosis

A

cholangiocarcinoma and current alcohol/drug abuse

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14
Q

You are scanning through the liver and note the caudate lobe is nearly the same size as the right lobe. The surface of the liver appears lobulated or nodular. Which of the following is the most likely diagnosis of these findings?

FNH
cirrhosis
hepatitis
HCC

A

cirrhosis

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15
Q

Which of the following organs can be involved in this multi-organ syndrome and can also display the same abnormality seen here in the liver?

thyroid and thymus
peritoneum and mesentery
kidneys and ovaries
spleen and adrenal glands

A

kidneys and ovaries

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16
Q

Alcoholic cirrhosis demonstrates a severe increase in ___, while viral hepatitis demonstrates a severe increase in ___.

AFP, ALP
AST, ALT
ALP, AFP
ALT, AST

A

AST, ALT

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17
Q

Which of the following correctly describes peliosis hepatis?

blood filled cavities of varied size form in the liver tissue

numerous AV fistulas form throughout the liver

infection of the cystic duct that transfers to the pancreas

numerous cysts form that connect to the extrahepatic portal vein

A

blood filled cavities of varied size form in the liver tissue

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18
Q

What liver abnormality results in low blood sugar levels?

hemangioma
FNH
glycogen storage disease
Wilson disease

A

glycogen storage disease

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19
Q

In patients with cirrhosis, what effect will deep inspiration have on the portal vein?

the PV diameter will increase by 50%
the PV will collapse at the deepest point of inspiration
there will be minimal change in the PV diameter
the PV diameter will double in size

A

there will be minimal change in the PV diameter

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20
Q

The findings on the image are most consistent with:

subcapsular hematoma of the liver
intraparenchymal hematoma of the liver
loculated pleural effusion
subcapsular hematoma of the spleen

A

subcapsular hematoma of the liver

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21
Q

The most common cause of spread of hepatitis in the US is:

blood transfusions
hereditary infection
IV drug users
liver transplants

A

IV drug users

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22
Q

A patient presents with splenomegaly and multiple, small, tortuous vessels are visualized in the porta hepatis area of the liver. These vessels most likely represent:

duplicated HA
cavernous transformation
dilated extrahepatic biliary system
portal aneurysm

A

cavernous transformation

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23
Q

___ should be suspected in an infant with a large hepatic hemangioma and unexplained thrombocytopenia.

Budd Chiari
cirrhosis
Kasabach-Merritt syndrome
fragile X syndrome

A

Kasabach-Merritt syndrome

**aka hemangioma thrombocytopenia syndrome

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24
Q

Steatosis refers to:

glycogen storage disease of the liver
chronic hepatitis infection
fatty liver disease
pneumocystis carinii

A

fatty liver disease

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25
Q

A RI over 0.8 in the common hepatic artery would be an expected finding in patients with:

cholangitis and steatosis
PHTN and transplant rejection
FNH and cirrhosis
Budd Chiari and a healthy liver transplant

A

PHTN and transplant rejection

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26
Q

___ is the most common cause for micronodular cirrhosis and ___ is the most common cause of macronodular cirrhosis.

analgesic consumption, alcohol consumption
alcohol consumption, chronic viral hepatitis
chronic viral hepatitis, alcohol consumption
alcohol consumption, analgesic consumption

A

alcohol consumption, chronic viral hepatitis

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27
Q

A liver mass with a hypoechoic rim should create a strong suspicion of:

a hepatic lipoma
PHTN
a liver adenoma
malignancy

A

malignancy

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28
Q

Which of the following is a potential collateral pathway formed in patients with cirrhosis?

blood moves from the gastric vein to the splenic vein

blood moves from the superior rectal vein to middle rectal vein

blood moves from the splenic vein to the coronary vein

blood moves from the emissary veins to the umbilical vein

A

blood moves from the superior rectal vein to middle rectal vein

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29
Q

Benign liver masses will usually demonstrate ultrasound contrast enhancement during the arterial and portal venous phases of imaging. Malignant masses will usually demonstrate:

no contrast enhancement

contrast enhancement during portal venous phase of imaging

contrast enhancement during the arterial and portal venous phases of imaging

contrast enhancement during the arterial phase of imaging

A

contrast enhancement during the arterial phase of imaging

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30
Q

A 65 year old male presents with a history of cirrhosis, RUQ pain, and recent weight loss over the last 6 months. Lab testing indicates abnormal LFTs and increased AFP. The image displayed is most suggestive of:

HCC
focal fatty sparing
TCC
metastasis

A

HCC

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31
Q

A 75 year old female presents with RUQ pain. She was diagnosed with cirrhosis 4 years ago. Lab values demonstrate increased levels of AFP, ALP, AST, and ALT. The US exam demonstrates a heterogenous liver texture that is decreased in size. The left lobe contains a new round hypoechoic mass with increased vascularity. These findings are most suggestive of:

hydatid cyst
metastatic lesion
FNH
HCC

A

HCC

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32
Q

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

the patient’s liver is increased in echogenicity indicating acute viral hepatitis

bilirubin, AST and ALT levels will be elevated

the patient has a pleural effusion

the patient’s liver is decreased in echogenicity indicating cirrhosis

A

bilirubin, AST and ALT levels will be elevated

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33
Q

In a patient with cirrhosis, the __ lobe of the liver can enlarge to nearly half the size of the right lobe.

left
caudate
quadrate
none of the above, the entire liver shrinks in size

A

caudate

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34
Q

A patient presents with an isolated slight increase in liver function tests. You identify two hyperechoic, homogenous masses in the area of the porta hepatis. These findings are most consistent with:

focal fatty sparing
cavernous hemangioma formation
focal fatty infiltration
adenoma development

A

focal fatty infiltration

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35
Q

Liver elastography is used for:

staging of secondary malignancy
staging of primary malignancy
staging of steatosis
staging of fibrosis

A

staging of fibrosis

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36
Q

If this is a TRV view of the liver, where is the liver mass located?

lateral right
anterior right
caudate
lateral left

A

anterior right

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37
Q

A patient presents with a history of gastric carcinoma diagnosis. The image most likely demonstrates which of the following abnormalities?

HCC
metastatic lesions
GB carcinoma
PCLD

A

metastatic lesions

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38
Q

___ can lead to air within the portal venous system and ___ can lead to air within the biliary tree.

an ERCP, ulcerative colitis
diverticulitis, ulcerative colitis
ulcerative colitis, an ERCP
ulcerative colitis, appendicitis

A

ulcerative colitis, an ERCP

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39
Q

A cyst within a cyst (daughter cyst) is a classic sign of:

polycystic liver disease
hydatid cyst or fungal abscess
echinococcal cyst or pyogenic abscess
hydatid cyst or echinococcal cyst

A

hydatid cyst or echinococcal cyst

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40
Q

Which of the following is commonly associated with contaminated water and causes debris/occlusion within intrahepatic portal venous system?

schistosomiasis
pyogenic abscess
candidiasis
amebic abscess

A

schistosomiasis

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41
Q

A 45 year old male presents for an abdominal US due to suspected hepatomegaly. The exam demonstrates numerous cysts of all sizes throughout the liver parenchyma. Which of the following should be evaluated for the same abnormality?

pancreas
retroperitoneal lymph nodes
prostate
ovaries

A

pancreas

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42
Q

Which of the following correctly describes how to differentiate a liver hemangioma from focal fatty infiltration?

hemangiomas demonstrate internal vascularity, while focal fatty infiltration demonstrates peripheral vascularity

there are no distinguishing sonographic characteristics between liver hemangiomas and focal fatty infiltration

hemangiomas can compress or displace surrounding structures, fatty infiltration has no mass effect

hemangiomas are always identified in the right lobe, while focal fatty infiltrations always occurs at the porta hepatis

A

hemangiomas can compress or displace surrounding structures, fatty infiltration has no mass effect

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43
Q

Which of the following will cause an increase in values on liver function tests?

FNH
polycystic liver disease
adenoma
hepatitis

A

hepatitis

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44
Q

A liver ultrasound demonstrates a hyperechoic mass with smooth borders and posterior enhancement in the posterior right lobe. These findings are most suggestive of:

HCC
cavernous hemangioma
hepatic adenoma
focal fatty sparing

A

cavernous hemangioma

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45
Q

If a patient presents with a history of right breast cancer and you identify a solid liver mass with a hypoechoic halo, what is the most likely diagnosis of the finding?

hepatic metastasis
FNH
HCC
hepatic adenoma

A

hepatic metastasis

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46
Q

A 4 year old patient is referred for an abdominal ultrasound due to a palpable mass in the RUQ and jaundice. The image most likely represents which of the following findings?

hepatoblastoma
hepatoma
pheochromocytoma
nephroblastoma

A

hepatoblastoma

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47
Q

A 26 year old female presents for an abdominal ultrasound. Her clinical history includes current use of oral contraceptives and mild hyperglycemia. The image of the liver is most suggestive of:

normal liver echotexture, no masses/abnormalities identified

adenoma formation in the right lobe, posteriorly

focal fatty sparing in the left lobe, posteriorly

focal fatty sparing in the right lobe, posteriorly

A

adenoma formation in the right lobe, posteriorly

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48
Q

Placement of a Linton or Warren shunt is a method used to:

reroute blood flow around a large aortic aneurysm

streamline blood flow through a large aortic aneurysm

reduce PHTN

relieve significant hydronephrosis

A

reduce PHTN

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49
Q

Which of the following would cause an increase in serum AST levels with normal serum ALT levels?

CHF
hepatitis
metastasis
cirrhosis

A

CHF

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50
Q

Which lobe of the liver contains the mass?

lateral left lobe
anterior right lobe
medial left lobe
posterior right lobe

A

anterior right lobe

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51
Q

A 50 year old female presents with nausea, vomiting and increased levels of AFP in lab testing. Which of the following pathologies is demonstrated on the image displayed?

hepatoblastoma
klatskin tumor
krukenberg tumor
choledochal cysts

A

klatskin tumor

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52
Q

Which of the following is not an expected finding with fatty infiltration of the liver?

cystic degeneration
increased attenuation
degraded visualization of vessels
brighter parenchymal echoes

A

cystic degeneration

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53
Q

Which of the following is not an expected complication of a liver transplant?

abscess
biloma
urinoma
seroma

A

urinoma

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54
Q

The findings on the image are most suggestive of:

right heart failure
cirrhosis
Wilson disease
Budd Chiari disease

A

cirrhosis

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55
Q

The most common benign liver tumor is:

cavernous hemangioma
klatskin tumor
polycystic liver disease
hepatitis

A

cavernous hemangioma

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56
Q

Which waveform represents hepatic vein flow in a patient with advanced cirrhosis?
*** the color map displayed applies to all displayed Doppler tracings

A

B

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57
Q

A patient presents for a liver ultrasound. A 5cm mass is identified at the porta hepatis of the liver. How will this affect the IVC position in the abdomen?

IVC will be displaced posteriorly
IVC will be displaced anteriorly
IVC will be displaced inferiorly
a 6cm mass is not large enough to displace the IVC in most patients

A

IVC will be displaced posteriorly

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58
Q

Which of the following describes the sonographic appearance of hepatic candidiasis?

cystic mass with gravity dependent debris

mass formation is described as a wheel within a wheel pattern

complex cystic mass that typically forms near the porta hepatis

a large solid mass replaces the caudate lobe and displaces the IVC

A

mass formation is described as a wheel within a wheel pattern

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59
Q

Which of the following would indicate a normal Doppler evaluation of an intrahepatic shunt?

hepatofugal flow in the MPV
peak flow velocity of 35cm/s
peak flow velocity of 230cm/s
hepatofugal flow in the LPV

A

hepatofugal flow in the LPV

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60
Q

Liver transplant evaluation requires PW Doppler evaluation of all of the following, EXCEPT:

portal anastomosis
IVC anastomosis
hepatic arterial anastomosis
biliary anastomosis

A

biliary anastomosis - should be evaluated for obstruction of fluid collection using 2D ultrasound

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61
Q

What is the most common cause of a hepatic abscess in the US?

osteomyelitis and endocarditis
appendicitis and diverticulitis
cholangitis and cholecystitis
E. coli from digestive tract

A

cholangitis and cholecystitis

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62
Q

What is a potentially life threatening complication of PHTN?

ruptured gastroesophageal varices
ascites formation
aortic embolism
pulmonary embolism

A

ruptured gastroesophageal varices

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63
Q

Which of the following is a potential collateral pathway formed in patients with cirrhosis?

blood moves from the emissary veins into the umbilical vein

blood moves from the gastric vein into the splenic vein

blood moves from the splenic vein into the coronary vein

blood moves from the coronary and short gastric veins into the esophageal veins

A

blood moves from the coronary and short gastric veins into the esophageal veins

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64
Q

If a liver transplant patient has an interposition anastomosis, how does this affect your evaluation?

there will be two anastomosis sites in the IVC that must be evaluated

each hepatic vein is connected to the native IVC separately, so there will be three anastomosis sites in the IVC that must be evaluated

the HA anastomosis will not be able to visualized because it is located deep within the liver tissue

there will be two anastomosis sites in the MPV that must be evaluated

A

there will be two anastomosis sites in the IVC that must be evaluated

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65
Q

The Ultrasound Liver Imaging Reporting and Data System (US LI-RADS) is used to asses patients at risk for:

lymphoma
liver metastasis
cirrhosis
HCC

A

HCC

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66
Q

Which of the following describes the location of the mass within the liver?

lateral left lobe
anterior right lobe
medial left lobe
posterior right lobe

A

medial left lobe

**TRV view of the liver, the mass is anterior and between the left and middle hepatic vein

67
Q

Which of the following findings indicates a failed transjugular intrahepatic shunt?

continuous flow pattern within the shunt
diminished flow in the right and left portal branches
spleen length <12cm in average patient
hepatofugal flow in the MPV

A

hepatofugal flow in the MPV

68
Q

What fetal syndrome is most commonly associated with hepatoblastoma?

trisomy
Beckwith-Wiedemann syndrome
Budd Chiari
down syndrome

A

Beckwith-Wiedemann syndrome

69
Q

What is caput medusa?

formation of splenorenal varices
failure of a TIPS shunt
tortuous vessels around the umbilicus caused by PHTN
formation of gastroesophageal varices

A

tortuous vessels around the umbilicus caused by PHTN

70
Q

Which of the following is a contraindication to placement of a TIPS shunt?

HCC
cirrhosis
portal thrombosis
HA aneurysm

A

portal thrombosis

** thrombus could then travel from the PV to the IVC and into the lungs causing pulmonary embolism

71
Q

While performing ultrasound on the liver, a TRV view reveals a hyperechoic triangular structure in the inferior left lobe. The hyperechoic structure demonstrates an anechoic center that fills with color when Doppler is applied. Which of the following best describes the finding identified on the image?

recanalized coronary vein
recanalized umbilical vein
metastaisis
FNH

A

recanalized umbilical vein

72
Q

What liver complication is associated with cholangitis, diverticulitis, and osteomyelitis?

steatosis
fungal abscess
pyogenic abscess
metastasis

A

pyogenic abscess

73
Q

A portal vein diameter that is greater than or equal to ___ indicates PHTN.

8mm
10mm
13mm
15mm

A

13mm

74
Q

Which of the following is most likely to demonstrate a simple cyst with gravity dependent debris in the right lobe of the liver?

early schistosomiasis infection
chronic FNH
early echinococcal infection
chronic hydatid infection

A

early echinococcal infection

75
Q

Which of the following Doppler characteristics of the hepatic arteries will be seen in a normal liver transplant?

increased RI
sharp systolic upstroke
prolonged acceleration time
diastolic flow reversal

A

sharp systolic upstroke

76
Q

A patient presents with a history of RUQ pain. He currently uses anabolic steroids. The exam demonstrates multiple irregular anechoic areas throughout the liver parenchyma. No internal flow is documented in these areas on color Doppler evaluation. These findings are most suggestive of:

peliosis hepatis
metastatic disease from colon primary
HCC
Budd Chiari

A

peliosis hepatis

77
Q

A 28 year old male presents with jaundice, increased AST and ALT, decreased albumin and elevated serum copper levels. The liver appears diffusely echogenic with periportal thickening. These findings are most suggestive of:

alcoholic cirrhosis
chronic hepatitis
glycogen storage disease
Wilson disease

A

Wilson disease

78
Q

A patient presents with new onset of jaundice 2 weeks after a liver transplant. This clinical finding is most suggestive of what complication?

HA stenosis
biliary stricture
HV stenosis
PV stenosis

A

biliary stricture

79
Q

Which of the following Doppler parameters is most commonly used when evaluating the common hepatic artery in a patient with a liver transplant?

S/D ratio
PI
PSV
RI

A

RI

** RI >0.8 implies PHTN, hepatic congestion, transplant rejection, or chronic hepatocellular disease

80
Q

What is the most common primary cancer to metastasize to the liver?

ovary
GI tract
melanoma
lung

A
  1. GI tract
  2. pancreas
  3. breast
  4. lung
  5. ovary
81
Q

Which of the following statements is true regarding the sonographic appearance of fatty infiltration?

as fatty infiltration increases in the liver, the HV branches become increasingly visible

as fatty infiltration increases in the liver, all walls of all liver vascularity become increasingly echogenic

as fatty infiltration increases in the liver, the PV branches become more difficult to visualize

as fatty infiltration increases in the liver, the walls of the PV branches become increasingly echogenic

A

as fatty infiltration increases in the liver, the PV branches become more difficult to visualize

82
Q

Diastolic flow reversal in the right and left hepatic arteries of a newly placed liver allograft indicates:

significant stenosis of the common hepatic artery
PHTN
normal post-surgical findings
possible rejection

A

possible rejection

83
Q

A ___ abscess is caused by bacteria and most commonly forms within the right lobe of the liver. A ___ abscess is caused by a parasite and usually forms in the right dome of the liver causing elevation of the diaphragm.

fungal, pyogenic
parasitic, fungal
amebic, pyogenic
pyogenic, amebic

A

pyogenic, amebic

84
Q

Which of the following liver tumors is usually treated by surgical resection due to risk of hemorrhage and malignant transformation?

hemangioma
adenoma
pyogenic abscess
lipoma

A

adenoma

85
Q

___ is the most common malignant liver mass found in children.

mets from brain
hepatoblastoma
hepatoma
mets from nephroblastoma

A

hepatoblastoma

86
Q

Reduced glycogen storage in the liver usually causes the liver parenchyma to have a sonographic appearance similar to:

polycystic disease
acute viral hepatitis
cirrhosis
steatosis

A

acute viral hepatitis

87
Q

If discovered in early stages, which of the following effects on the liver can be reversed?

cirrhosis
fatty infiltration
hepatoma
metastasis

A

fatty infiltration

88
Q

A contrast enhanced ultrasound examination is performed on a patient with suspected HCC. What are the expected findings if the exam is positive?

hypoechoic lesions during the arterial phase and hyperechoic lesions during the portal venous phase

hyperechoic lesions during the arterial phase and hypoechoic lesions during the portal venous phase

hypoechoic lesions that demonstrate absence of contrast uptake throughout the arterial and venous phases of circulation

hyperechoic lesions that demonstrate sustained levels of contrast uptake throughout the arterial and venous phases of circulation

A

hyperechoic lesions during the arterial phase and hypoechoic lesions during the portal venous phase

89
Q

A patient presents for an abdominal ultrasound with a history of increased LFTs and obesity. The referring doctor would like to rule out hepatomegaly. Which of the following findings will indicate hepatomegaly is present?

when the right lobe is rounded inferiorly and extends past the upper pole of the right kidney

when the right lobe is rounded inferiorly and extends below the lower pole of the right kidney

hepatomegaly causes rounding of the superior liver segments

the liver is considered enlarged when the AP measurement exceeds 15.5cm

A

when the right lobe is rounded inferiorly and extends below the lower pole of the right kidney

90
Q

Which of the following sonographic characteristics is associated with Budd Chiari syndrome?

dilated IVC
portal system aneurysm
agenesis of the HA
atrophied HVs

A

atrophied HVs

91
Q

___ lobe of the liver does not normally atrophy with chronic Budd Chiari

caudate
right anterior
right posterior
left medial

A

caudate

92
Q

Which of the following correctly describes how to determine if a peripheral mass is intrahepatic or extrahepatic?

evaluate the biliary tree for the presence of dilatation which is only seen with an extrahepatic mass

assess the liver capsule and look for indentations that indicate extrahepatic origin or outward bulging that indicates intrahepatic origin

assess the location of the mass in relation to the stomach

use PW Doppler to obtain the RI of the lesion and compare it to the RI of the normal liver tissue

A

assess the liver capsule and look for indentations that indicate extrahepatic origin or outward bulging that indicates intrahepatic origin

93
Q

Which of the following describes the sonographic appearance of FNH?

single or multiple hypoechoic, rounded masses with mild posterior shadowing within the liver parenchyma

a single hyperechoic mass most commonly found adjacent to the porta hepatis

a single mass <5cm with a central scar and prominent central and radial vascularity

diffuse echogenic nodules or foci scattered throughout the liver parenchyma

A

a single mass <5cm with a central scar and prominent central and radial vascularity

94
Q

Compensatory enlargement of the caudate lobe occurs with which of the following?

Wilson disease and glycogen storage disease
cirrhosis and acute hepatitis
fatty infiltration and glycogen storage disease
cirrhosis and Budd Chiari

A

cirrhosis and Budd Chiari

95
Q

A 43 year old female with a history of Hep C presents with jaundice, increased abdominal girth and pain. The most probable US finding in the liver will be:

metastasis from GI tract
cirrhosis and ascites
schistosomiasis and splenic atrophy
fatty filtration

A

cirrhosis and ascites

96
Q

Contrast enhanced ultrasound is used to determine the outcome of tumor ablation in the liver. If the procedure was a success, what are the expected findings on the image?

consistent contrast uptake occurs during the arterial and venous phase

contrast uptake occurs during the venous phase

contrast uptake occurs during the arterial phase

no contrast enters the lesion during the cardiac cycle

A

no contrast enters the lesion during the cardiac cycle

97
Q

A patient presents for a liver ultrasound due to a history of cirrhosis. The prior US report indicates the presence of a dilated umbilical vein. What is the proper probe position and location needed to demonstrate the umbilical vein as seen in the image?

TRV, subcostal angulation
SAG, intercostal
SAG, just to the right of midline
SAG, just to the left of midline

A

SAG, just to the left of midline

98
Q

Which liver disorder leads to the sonographic appearance of hepatomegaly with decreased echogenicity and scattered bright portal reflections within the parenchyma?

acute viral hepatitis
hydatid disease
chronic viral hepatitis
cirrhosis

A

acute viral hepatitis

99
Q

High-intensity transient signals (HITS) are seen on the Doppler evaluation of a patient with:

portal venous gas
hyperfunctioning adenoma
significant aortic stenosis
critical RA stenosis

A

portal venous gas

100
Q

Which liver mass demonstrates characteristics most consistent with a klatskin tumor?

A
101
Q

What usually causes an echinococcal cyst in the liver?

hepatitis
ingestion of raw oysters
hemangioma
ingestion of raw pork

A

ingestion of raw pork

102
Q

The US exam of a patient’s liver demonstrates a patent umbilical vein. The most common cause for this recanalization is:

PHTN
hepatitis
ascites
abscess

A

PHTN

103
Q

A 10 year old presents for an abdominal ultrasound with a palpable RUQ mass. He has no history of liver disease and AFP levels are normal. You identify a 9cm mass in the right lobe that demonstrates punctuate calcifications and a central scar. These findings are most suggestive of:

hepatoblastoma
fibrolamellar carcinoma
hepatoma
metastasis

A

fibrolamellar carcinoma

** subtype of HCC found in adolescents and young adults

104
Q

What is the yellow arrow pointing to?

IVC tumor extension
mass in the CBD
retroperitoneal lymphadenopathy
thrombus in the PV

A

thrombus in the PV

105
Q

About 50% of all primary tumors that metastasize to the liver are drained through the:

AO
HV
IVC
PV

A

PV

106
Q

Which of the following liver abnormalities is commonly associated with the recanalization of the vessel within the structure indicated by the purple arrows?

acute hepatitis
cirrhosis
fatty infiltration
hydatid disease

A

cirrhosis

107
Q

A mass that presents with a bull’s eye appearance within the liver tissue is most likely ___.

fatty sparing
lymphoma
FNH
metastasis

A

metastasis

108
Q

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

the liver is demonstrated in the TRV plane at the level of the caudate lobe and has a normal echotexture

there is a mass identified in the lateral left lobe of the liver adjacent to the IVC

there is a mass identified in the medial left lobe of the liver adjacent to the IVC

the liver is demonstrated in the TRV plane at the levels of the caudate lobe and has a normal echotexture. there is an enlarged lymph node seen anterior to the AO and adjacent to the IVC

A

there is a mass identified in the medial left lobe of the liver adjacent to the IVC

109
Q

Which type of liver abscess is caused by a parasite?

pyogenic
fungal
amebic
viral

A

amebic

110
Q

A patient presents for a follow up ultrasound due to Budd Chiari. Which of the following is an expected finding on the exam?

thrombosis of the HVs with hepatic congestion
adrenal adenoma and/or kidney adenoma
pancreatic head mass and dilated intrahepatic ducts
prostatitis and neurogenic bladder

A

thrombosis of the HVs with hepatic congestion

111
Q

Which of the following is true regarding a liver hemangioma?

fluid and debris levels are commonly present

a hemangioma is composed of an abnormal concentration of smooth muscle and Kupffer cells within the liver

Color Doppler is not usually helpful in evaluating this highly vascular mass

most hemangiomas demonstrate some level of posterior shadowing

A

Color Doppler is not usually helpful in evaluating this highly vascular mass

112
Q

When reviewing a prior US exam for an upcoming follow up exam for the same patient, you come across an image labeled “sandwich sign.” What are they referring to?

extrinsic compression of the IVC by a pancreatic tumor

the layering of the stomach wall at the head of the pancreas

lymphadenopathy surrounding the PV

the head of the pancreas is abnormally compressed between the liver and great vessels

A

lymphadenopathy surrounding the PV

113
Q

A vascular condition of the liver seen in women who take oral contraceptives is:

hereditary telangiectasia
liver adenoma
Budd Chiari
portal aneurysm

A

Budd Chiari

114
Q

Hypoalbuminemia associated with cirrhosis leads to:

GB and bowel wall thickening
liver capsule contraction and surface irregularities
hepatomegaly
nodule formation

A

GB and bowel wall thickening

115
Q

Which metabolic infiltrative disorder is associated with hepatic adenoma formation?

amyloidosis
Von Gierke disease
Wilson disease
hemochromatosis

A

Von Gierke disease

116
Q

A patient is referred for an abdominal ultrasound after a CT demonstrated a possible mass near the fundus of the GB. The ultrasound demonstrates mild hepatomegaly with a mild diffuse increase in echogenicity. The area in question appears hypoechoic to the surrounding tissues. These findings are most consistent with:

hepatic adenoma
focal fatty sparing
diffuse fatty infiltration
cystic artery thrombosis

A

focal fatty sparing

117
Q

A patient is referred for a RUQ scan due to the possibility of a fungal infection of the liver. They have a 4 year history of treatment for AIDS. The liver demonstrates diffuse presentation of multiple calcifications of different sizes, with and without shadowing. These findings are most consistent with:

steatosis
liver
pneumocystis carinii
hydatid sand from echinococcal infection

A

pneumocystis carinii

118
Q

A patient presents with abdominal pain for 3 months following a missionary trip to India. Lab values demonstrate normal LFTs. The US exam demonstrates a 3cm cyst with septations in the right lobe of liver. These findings are most consistent with:

candidiasis
hydatid disease
histoplasmosis infection
schistosomiasis

A

hydatid disease

119
Q

Schistosomiasis is an ___ cause of PHTN. Budd Chiari syndrome is an ___ cause of PHTN.

extrahepatic presinusoidal, intrahepatic postsinusoidal
intrahepatic presinusoidal, extrahepatic presinusoidal
intrahepatic presinusoidal, extrahepatic postinusoidal
intrahepatic presinusoidal, intrahepatic postsinusoidal

A

intrahepatic presinusoidal, intrahepatic postsinusoidal

120
Q

Which of the following describes the appearance of the liver in a patient in the later stages of cirrhosis caused by viral hepatitis?

diffuse coarse liver echotexture with no nodule formation
multiple nodules usually 1-5cm in size
significant hepatomegaly with diffuse decrease in hepatic echotexture
multiple nodules usually <1cm in size

A

multiple nodules usually 1-5cm in size

121
Q

Which liver pathology is most commonly associated with the GB pathology demonstrated on the image?

FNH
hepatitis
hepatoma
fatty infiltration

A

hepatitis

122
Q

Which of the following vessels will be abnormally dilated with significant PHTN?

MPV only
HVs only
MPV and left gastric vein
HVs, MPV, and left gastric vein

A

MPV and left gastric vein

123
Q

If a liver transplant patient has a piggyback anastomosis, how does this affect your evaluation?

there will be two anastomosis sites in the MPV that must be evaluated

the HA anastomosis will not be able to be visualized because it is located deep within the liver tissue

there will be a single anastomosis site in the IVC that must be evaluated

each HV is connected to the native IVC separately, so there will be three anastomosis sites in the IVC that must be evaluated

A

there will be a single anastomosis site in the IVC that must be evaluated

**piggyback - hepatic confluence of the transplant liver attached to native IVC (single anastomosis site)

interposition - donor IVC segment replaces a segment of the native IVC (two anastomosis sites)

124
Q

A patient is scheduled for abdominal ultrasound every 6 months due to their history of cirrhosis. Which of the following is true?

patients with cirrhosis should have their liver vasculature evaluated regularly due to an increased risk of tumor invasion from metastasis

patients with cirrhosis do not need to be evaluated regularly once the diagnosis has been made because the treatment options are limited

cirrhosis commonly leads to ascites which may require intermittent thoracentesis treatments

patients with cirrhosis should have their vasculature evaluated regularly due to an increased risk of portal thrombosis

A

patients with cirrhosis should have their vasculature evaluated regularly due to an increased risk of portal thrombosis

125
Q

___ usually presents as multiple target lesions in the liver

klatskin tumor
metastasis
fungal abscess
hydatid disease

A

metastasis

126
Q

What abnormality causes focal developmental lesions of the liver and is associated with congenital hepatic fibrosis, autosomal dominant polycystic disease and cholangiocarcinoma?

biliary hamartomas
Wilson disease
schistosomiasis
candidiasis

A

biliary hamartomas

127
Q

The most frequently involved organ in metastatic disease is the:

pancreas
spleen
liver
GI tract

A

liver

128
Q

All of the following statements correctly describe infantile hemangioendothelioma, EXCEPT:

usually spontaneously regresses before age 2 years

can lead to cardiac failure if associated with an AV malformation within the tumor

most common benign vascular tumor of the liver in infants and toddles

highly aggressive liver malignancy seen early in life

A

highly aggressive liver malignancy seen early in life

129
Q

A TIPS shunt is placed into the liver circulation to alleviate PHTN. What two vessels are usually connected?

RPV and LPV
HA and PV
RPV and RHV
RHV and LHV

A

RPV and RHV

130
Q

A patient presents with a history of AIDS and recent pneumocystis carinii infection. What charges to the liver do you expect to see on the ultrasound exam?

diffuse increase in liver tissue echogenicity with ascites
formation of multiple abscesses within the liver tissue
gas-producing abscess near the porta hepatis
diffuse echogenic foci throughout the liver tissue

A

diffuse echogenic foci throughout the liver tissue

131
Q

___ is the most common liver malignancy, while ___ is the most common primary liver malignancy

HCC, metastasis
HCC, Kaposi sarcoma
metastasis, HCC
HCC, fibrolamellar carcinoma

A

metastasis, HCC

132
Q

A 40 year old female patient presents with increasing RUQ pain over the last month, beginning upon returning from a trip to Indonesia. The findings on her exam are most consistent with:

echinococcal cyst
schistosomiasis cyst
lymphatic cyst
fungal abscess

A

echinococcal cyst

133
Q

A patient presents with a history of Hep C and you identify a solid liver mass with a hypoechoic halo. This finding is most consistent with:

HCC
FNH
hepatic adenoma
hepatic metastasis

A

HCC

134
Q

Which of the following is true regarding a liver hemangioma?

Color Doppler is a valuable tool in evaluating this highly vascular mass

fluid and debris levels are commonly present in a hemangioma

most hemangiomas demonstrate some level of posterior shadowing

a hemangioma is comprised of an abnormal concentration of vascular tissues within the liver

A

a hemangioma is comprised of an abnormal concentration of vascular tissues within the liver

135
Q

A patient is scanned for symptoms of mild epigastric pain. A nearly isoechoic liver mass is identified in the caudate lobe. A liver biopsy demonstrates normal liver cell structure but abnormal cellular arrangement. What type of mass was identified on the US image?

FNH
hepatoma
hemangioma
adenoma

A

FNH

**usually isoechoic to mildly hypoechoic to the liver tissue

136
Q

A patient presens with increasing RUQ pain and vomiting after a recent liver biopsy. An irregular mass with internal debris and an overall heterogenous appearance is noted in the right lobe. The mass also demonstrates several echogenic foci with ringdown artifact. These findings are most suggestive of:

hematoma
abscess
lymphocele
pseudoaneurysm

A

abscess

137
Q

How can a hepatic adenoma be differentiated from FNH on contrast enhanced ultrasound?

FNH lesions usually demonstrate centripetal enhancement while adenomas demonstrate centrifugal enhancement

FNH lesions demonstrate significant contrast uptake while adenomas demonstrate no contrast uptake

FNH lesions demonstrate no contrast uptake while adenoms demonstrate significant contrast uptake

FNH lesions usually demonstrate centrifugal enhancement while adenomas demonstrate centripetal enhancement

A

FNH lesions usually demonstrate centrifugal enhancement while adenomas demonstrate centripetal enhancement

138
Q

Portalization of the HVs is a common finding in which of the following?

mild to moderate steatosis
severe tricuspid valve regurgitation
hemolytic anemia
advanced cirrhosis

A

advanced cirrhosis

139
Q

The primary finding that differentiates liver mass formation from steatosis is:

steatosis will cause wall thickening of the portal system while mass formation invades the wall

steatosis causes an irregular liver surface contour while mass formation does not effect the surface contour of the liver

steatosis will demonstrate normal vessel course through affected areas while mass formation displaces vasculature

steatosis will cause dilated HVs while mass formation will cause narrowed HVs

A

steatosis will demonstrate normal vessel course through affected areas while mass formation displaces vasculature

140
Q

Liver hemangiomas are a common benign neoplasm that will usually appear on an US of a normal liver as:

cystic mass within the liver
well defined, hyperechoic liver mass
complex liver mass with irregular borders
solid hypoechoic mass with posterior shadowing

A

well defined, hyperechoic liver mass

141
Q

Which type of liver abscess presents as a mass with internal septations similar to the spokes of a wheel?

fungal
viral
amebic
pyogenic

A

fungal

142
Q

Periportal cuffing is a sign of:

acute viral hepatitis
Caroli disease
intrahepatic biliary tree obstruction
extrahepatic biliary tree obstruction

A

acute viral hepatitis

143
Q

Fulminant hepatitis is most commonly caused by:

acetaminophen abuse
alcohol abuse
viral infection
fungal infection

A

acetaminophen abuse

144
Q

Which of the following describes the expected waveform from the HV in a patient with cirrhosis?

triphasic, highly pulsatile antegrade flow
monophasic, continuous retrograde flow
monophasic, continuous antegrade flow
triphasic antegrade flow without cardiac pulsatility

A

monophasic, continuous antegrade flow

145
Q

Which of the following describes the Doppler appearance of liver transplant rejection?

mottled appearance of the liver parenchyma with ascites
low resistance flow in the PV
high resistance flow in the HA
nodular formations within the liver parenchyma

A

high resistance flow in the HA

146
Q

In what lobe of the liver is the mass located?

right
caudate
the mass is within the IVC not the liver
left

A

caudate

147
Q

What is the most common liver malignancy identified on ultrasound?

hepatoma
metastatic tumor
klatskin tumor
adenoma

A

metastatic tumor

148
Q

A 6 month old female is referred for an abdominal ultrasound due to suspected Kasabach-Merritt syndrome. What are you looking for on the exam?

liver or spleen hemangioma formation
pancreatic divisum
ascites, pleural effusion and abscess formation in the abdominal wall
absence of the biliary tree

A

liver or spleen hemangioma formation

149
Q

Which of the following is true regarding a transjugular intrahepatic shunt?

air is retained within the shunt after placement which limits the US evaluation for the first 3-5 days

the shunt is advanced into the liver through a puncture of the groin and common iliac vein

a harvested branch of the HV is normally used as the shunt

the shunt connects the dilated umbilical vein to the IVC

A

air is retained within the shunt after placement which limits the US evaluation for the first 3-5 days

150
Q

Shear wave elastography can be used to assess the liver. Which of the following correctly describes the results of an abnormal exam?

higher values indicate liver fibrosis

red color superimposed over liver parenchyma indicates liver fibrosis

lower values indicate liver fibrosis

blue color superimposed over liver parenchyma indicates liver fibrosis

A

higher values indicate liver fibrosis

<5kPA = normal
13-17kPA = highly suggestive of advanced chronic liver disease
>17kPA = highly suggestive of clinically significant PHTN

151
Q

A patient presents for a liver ultrasound due to a history of cirrhosis. While scanning in the subcostal SAG plane, just to the left of midline, you obtain the images displayed below. Which of the following best describes the findings?

splenic varices
patent umbilical vein
dilated MPV
esophageal varices

A

patent umbilical vein

152
Q

The most common parasitic infection in humans is:

pneumocystis carinii
hepatitis
schistosomiasis
hydatid disease

A

schistosomiasis

153
Q

If tardus parvus waveforms are identified in the intrahepatic artery waveforms of a transplant, this finding is ___. If biphasic waveforms are identified in the right and left hepatic arteries, the finding is ___.

suspicious for HA stenosis, normal
normal, suspicious for HA stenosis
suspicious for organ rejection, suspicious for HA stenosis
suspicious for HA stenosis, suspicious for organ rejection

A

suspicious for HA stenosis, suspicious for organ rejection

154
Q

Cirrhosis causes reduced serum albumin levels. What complication does this cause?

increased ammonia production
ascites and peripheral edema
jaundice
recanalization of the umbilical vein

A

ascites and peripheral edema

155
Q

Triglyceride accumulation in the liver leads to ___, while copper accumulation in the liver leads to ___.

steatosis, hemochromatosis
amyloidosis, hemochromatosis
amyloidosis, steatosis
steatosis, Wilson disease

A

steatosis, Wilson disease

156
Q

Longitudinal images are presented of the anterior abdomen just superior to the umbilicus. What is the most common cause of the abnormality seen?

PHTN
polycythemia vera
malignant HTN
steatosis

A

PHTN

157
Q

A patient presents with lower extremity edema and increased abdominal girth 2 weeks after a liver transplant. These findings are most suggestive of what complications?

HV stenosis
cholangitis
HA stenosis
biliary stricture

A

HV stenosis

158
Q

Which of the following is the most common cause for intrahepatic cholestasis?

hepatitis
pancreatic head mass
stone in the distal CBD
fatty infiltration of the liver

A

hepatitis

159
Q

HA hypertrophy is a common finding with:

celiac axis stenosis
splenic vein thrombosis
cirrhosis
cholecystitis

A

cirrhosis

160
Q

Which of the following describes the most common sonographic appearance of hepatoma?

solid mass that may be more or less echogenic than the liver parenchyma

usually causes multiple diffuse solid mass formation

most commonly demonstrates diffuse coarse liver texture in the affected lobe

echogenic mass with a central scar

A

solid mass that may be more or less echogenic than the liver parenchyma

161
Q

Which of the following correctly describes how contrast enhanced ultrasound can be used to differentiate benign and malignant masses?

significant contrast uptake occurs in malignant nodules, while no contrast uptake is seen in benign nodules

significant contrast uptake occurs in benign nodules, while no contrast uptake is seen in malignant nodules

benign nodules usually demonstrate hypervascular enhancement while malignant tumors usually demonstrate hypovascular enhancement

benign nodules usually demonstrate isovascular enhancement while malignant tumors usually demonstrate hypervascular enhancement

A

benign nodules usually demonstrate isovascular enhancement while malignant tumors usually demonstrate hypervascular enhancement

162
Q

Portal thrombosis may lead to an accumulation of fluid in the abdomen called:

pleural effusion
pericardial effusion
ascites
retroperitoneal effusion

A

ascites

163
Q

The most definitive sonographic sign of cirrhosis is:

hepatoma formation
associated hepatomegaly
PHTN
decreased liver size with coarse texture and nodule formation

A

decreased liver size with coarse texture and nodule formation

ARDMS ABD REVIEW (27 decks)

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