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ARDMS ABD REVIEW > Pathology #4 > Flashcards

Pathology #4 Flashcards

1
Q

Which of the following describes the sonographic appearance of the pancreas with chronic cystic fibrosis?

decreased size and increased overall echogenicity

decreased size with hypoechoic nodularity throughout the gland

increased size with mottled echogenicity, no definite nodules

increased size with nodule and calcification formation

A

decreased size and increased overall echogenicity

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2
Q

Where is the abnormality located within the spleen, if the image displayed is a left lateral approach with coronal view?

there is a splenic infarct present in the anterior, medial splenic tissue

there is a splenic infarct present in the lateral, inferior splenic tissue

there is a splenic infarct is present in the anterior, superior splenic tissue

there is a splenic infarct present in the superior, medial splenic tissue

A

there is a splenic infarct present in the lateral, inferior splenic tissue

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3
Q

What congenital anomaly of the pancreas results in two separate ductal systems that drain the pancreas?

pancreas divisum
aberrant pancreatic tissue
pancreatic sequestration
annular pancreas

A

pancreas divisum

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4
Q

Glandular atrophy, dilated main duct, and intraductal calculi are hallmark signs of:

chronic cholecystitis
cholangitis
chronic renal failure
chronic pancreatitis

A

chronic pancreatitis

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5
Q

A pseudocyst most commonly forms in which retroperitoneal space?

posterior pararenal space
anterior pararenal space
omental bursa
perinephric space

A

anterior pararenal space

**they are seen in the omental bursa but that is within the peritoneal sac not the retroperitoneal space

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6
Q

All of the following are considered indirect signs of pancreatic adenocarcinoma, EXCEPT:

biliary ductal dilatation
hypoechoic mass in the pancreatic head
palpable GB
liver metastasis

A

hypoechoic mass in the pancreatic head

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7
Q

The double duct sign refers to the dilatation of:

the main pancreatic duct and accessory pancreatic duct
the CBD and cystic duct
right and left hepatic ducts
the CBD and duct of Wirsung

A

the CBD and duct of Wirsung

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8
Q

What do pancreatic adenocarcinoma and focal pancreatitis have in common?

both are usually treated using the Whipple procedure
both most commonly occur in the pancreatic head
both most commonly occur in the pancreatic tail
both cause a significant increase in AFP levels

A

both most commonly occur in the pancreatic head

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9
Q

Biliary atresia and congenital absence of the GB are associated with which complex congenital defect?

asplenia
pancreas divisum
polysplenia
annular pancreas

A

polysplenia

** aka double-left sidedness
associated with the formation of multiple spleens, right sided defects such as interrupted IVC, biliary atresia and absence of the GB

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10
Q

Which of the following is the cause of the findings on the images?

cholelithiasis
pancreatic adenocarcinoma
portal thrombosis
klatskin tumor

A

pancreatic adenocarcinoma

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11
Q

The most common cause of splenomegaly is ___.

PHTN
malignant HTN
AIDS
mononucleosis infection

A

PHTN

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12
Q

A patient tells you that they have undergone the Whipple procedure. What have they done?

liver resection
thyroidectomy
renal transplant
partial removal of the pancreas

A

partial removal of the pancreas

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13
Q

Which type of pancreatic mass has a strong risk of malignant conversion?

macrocystic cystadenoma
gastrinoma
insulinoma
microcystic cyst

A

macrocystic cystadenoma

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14
Q

What effect does polycythemia vera have on the sonographic appearance of the spleen?

diffuse increase in echogenicity and hypervascularity
multiple hypoechoic masses less than 1cm in diameter
multiple echogenic foci in an atrophied spleen
marked splenomegaly with normal echogenicity

A

marked splenomegaly with normal echogenicity

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15
Q

A patient presents for an abdominal ultrasound due to a history of elevated amylase. She was diagnosed 5 years ago with Von Hippel Lindau syndrome. You identify a round, lobulated hyperechoic mass in the body of the pancreas. Mild posterior enhancement is present. These findings are most suggestive of:

sphincter of oddi carcinoma
adenocarcinoma
microcystic cystadenoma
pseudocyst

A

microcystic cystadenoma

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16
Q

Which of the following correctly describes angiosarcoma of the spleen?

arises from the vascular endothelium and demonstrates increased vascularity

most common primary malignancy of the spleen

usually presents as a homogenous hyperechoic mass near the periphery of the spleen

very responsive to chemotherapy with good prognosis

A

arises from the vascular endothelium and demonstrates increased vascularity

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17
Q

When pancreatic enzymes leak into the peritoneal space, a ___ forms.

phlegmon
pseudocyst
cystadenoma
biloma

A

pseudocyst

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18
Q

Which of the following describes splenomegaly?

the spleen extends to a position immediately adjacent to the pancreatic tail

the spleen extends below the lower pole of the left kidney

the spleen extends below the upper pole of the left kidney

the spleen extends below the mid pole of the left kidney

A

the spleen extends below the lower pole of the left kidney

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19
Q

Massive splenomegaly is defined as a spleen that exceeds ___ in length.

15cm
13cm
23cm
18cm

A

18cm

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20
Q

A fluid collection between the diaphragm and splenic capsule may represent:

subphrenic abscess
subcapsular hematoma
pericardial effusion
pleural effusion

A

subphrenic abscess

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21
Q

A patient presents for a post-transplant evaluation of the pancreas. Where is the most common location for the allograft?

epigastric area
LLQ
right iliac fossa
periumbilical area

A

right iliac fossa

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22
Q

A patient presents with LUQ pain, loss of appetite and elevated levels of LDH. The findings on the image are most suggestive of:

mononucleosis
Non-Hodgkin lymphoma
granulomas
hamartomas

A

Non-Hodgkin lymphoma

**multiple hypoechoic nodules throughout the enlarged spleen, perisplenic lymph nodes visible outside the spleen, causes elevated LDH levels

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23
Q

Which of the following is associated with an autosplenectomy?

splenic hamartoma
wandering spleen
splenic lymphoma
sickle cell anemia

A

sickle cell anemia

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24
Q

It may be difficult to differentiate a ___ from splenic disease process at the hilum.

liver mass in the caudate lobe
duodenal tumor
pancreatic pseudocyst
right renal cyst in the upper pole

A

pancreatic pseudocyst

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25
Q

Gamna-Gandy bodies results in:

splenic calcifications
hypothyroidism
aneurysm formation in the splenic artery
aneurysm formation in the AO

A

splenic calcifications

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26
Q

A pseudocyst has no ___, which helps to differentiate it from a true pancreatic cyst.

pancreatic enzymes within it
epithelial lining
posterior shadowing
posterior enhancement

A

epithelial lining

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27
Q

When inflammation from pancreatitis extends into the tissues surrounding the pancreas, this called:

pseudocyst
cystadenoma
biloma
phlegmon

A

phlegmon

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28
Q

A patient presents with congenital absence of the spleen, this condition is called:

accessory spleen
splenomegaly
asplenia
hamartoma

A

asplenia

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29
Q

Which of the following are vascular complications seen with pancreatitis?

progression of Budd Chiari and the development of CHF

cholecystitis and phlegmon formation

thrombosis of the splenic vein or pseudoaneurysm of the splenic artery

PHTN and biliary strictures

A

thrombosis of the splenic vein or pseudoaneurysm of the splenic artery

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30
Q

Spontaneous splenic rupture is associated with all of the following, EXCEPT:

mononucleosis
trauma
HIV
splenosis

A

trauma

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31
Q

Weakened gastrosplenic and splenorenal ligaments can lead to:

polysplenia
situs inversus
asplenia
wandering spleen

A

wandering spleen

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32
Q

Alcohol abuse is the most common cause for:

acute pancreatitis
renal failure
cholecystitis
chronic pancreatitis

A

chronic pancreatitis

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33
Q

A disorder that affects the pancreas by causing it to excrete a thick mucus-like substance that inhibits the exocrine function is called:

tuberculosis
pancreatitis
insulinoma
cystic fibrosis

A

cystic fibrosis

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34
Q

Asplenia is associated with all of the following, EXCEPT:

congenital heart defects
AO on the right side of the body
absence of the spleen
liver on the right, GB on the left

A

liver on the right, GB on the left

**midline liver and GB

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35
Q

RCC, insulinoma, and pancreas cystadenoma are associated with what syndrome?

Beckwith-Wiedemann syndrome
multiple endocrine neoplasia syndrome
Gaucher disease
Von Hippel Lindau syndrome

A

Von Hippel Lindau syndrome

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36
Q

A patient presents with a recent history of a histoplasmosis infection. The referring doctor would like to evaluate the abdomen for residual effects from the infection. Which sonographic findings in the abdomen would be consistent with this type of infection?

mild to moderate ascites and splenomegaly

multiple echogenic foci in the liver and or spleen parenchyma

dilated ductal system of the liver with inflammation (cholangitis)

significant amount of loculated ascites in the bilateral paracolic gutters

A

multiple echogenic foci in the liver and or spleen parenchyma

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37
Q

Retrograde flow in the splenic artery would most likely indicate:

chronic systemic HTN
left gastric artery occlusion
mild PHTN
celiac axis occlusion

A

celiac axis occlusion

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38
Q

___ refers to a rare genetic disorder characterized by visceral cysts, renal and pancreatic cysts, benign masses, and the potential for malignant transformation in multiple organ systems.

Von Hippel Lindau syndrome
Edwards syndrome
Osler-Weber-Rendu syndrome
polycystic disease

A

Von Hippel Lindau syndrome

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38
Q

Splenic vein thrombosis and splenic artery pseudoaneurysm formation are vascular complications seen with:

RA stenosis
pancreatitis
cirrhosis
Zollinger Ellison syndrome

A

pancreatitis

39
Q

Which of the following correctly describes the findings on the image?

portal thrombosis
lymphadenopathy
klatskin tumor
normal anatomy

A

lymphadenopathy

40
Q

All of the following are potential malignant features of a pancreatic cyst, EXCEPT:

cyst size <3cm
increase in cyst size on serial exams
thickened septations
internal nodule

A

cyst size <3cm

**cysts >3cm should be suspected as malignant

41
Q

A patient presents for an abdominal ultrasound with a history of a renal and pancreatic transplant. What chronic medical condition is the primary reason for the double transplant?

pancreatic adenocarcinoma
chronic pancreatitis
hypertension
type I diabetes

A

type I diabetes

42
Q

The splenic vein measures 5mm in diameter. If the diameter remains constant with deep inspiration:

PHTN should be suspected
the celiac axis should be evaluated for obstruction
duodenal obstruction should be suspected
the response is normal

A

PHTN should be suspected

**splenic vein diameter increases 50-100% from deep inspiration, if increase <20% PHTN should be suspected

43
Q

A 56 year old male presents with acute onset of epigastric pain that has persisted for about 2 days. His lab tests demonstrate elevated amylase and lipase. Multiple mobile echogenic foci are present in the GB with a wall thickness of 2.4mm. The CBD measures 6mm and appears patent. The pancreas is mildly enlarged with posterior enhancement. Which of the following best describes these findings?

cystic fibrosis with cholelithiasis
acute pancreatitis with cholelithiasis
chronic pancreatitis with cholelithiasis
adenomyomatosis with cholelithiasis and cholecystitis

A

acute pancreatitis with cholelithiasis

44
Q

Which of the following is commonly associated with pancreatitis?

pancreatic divisum
high fat diet
low fat diet
annular pancreas

A

pancreatic divisum

45
Q

Which of the following is considered a direct sign of pancreatic adenocarcinoma?

hypoechoic mass in the pancreatic head
palpable GB
liver metastasis
biliary ductal dilation

A

hypoechoic mass in the pancreatic head

46
Q

The image demonstrates the most common form of pancreatic endocrine tumor (PET) of the pancreas. What type of PET is displayed?

insulinoma
pseudocyst
fibroma
adenoma

A

insulinoma

**3 types of PET, formerly known islet cell tumors (insulinoma, gastrinoma, glucagonoma)

47
Q

A patient presents with LUQ pain after a fall. Which of the following describes of findings seen on the image?

the spleen capsule has ruptured and hematoma formation has occurred

the spleen capsule is intact but there is an intraparenchymal and subcapsular hematoma present

splenic veins are dilated at the hilum and within the spleen, most likely related to PHTN

the spleen is surrounded by ascites

A

the spleen capsule is intact but there is an intraparenchymal and subcapsular hematoma present

48
Q

Tuberculosis and ___ will demonstrate similar ultrasound findings in the spleen.

infarction
hamartoma
hemangioma
sarcoidosis

A

sarcoidosis

49
Q

Which of the following statements regarding insulinomas is true?

commonly associated with peptic ulcer

most patients require an insulin pump to counteract the effects of the tumor on the serum glucose levels

they commonly occur in the head of the pancreas

patients are usually hypoglycemic

A

patients are usually hypoglycemic

50
Q

Splenic vein thrombosis is a common finding in patients with:

pancreatic divisum
splenic infarct
chronic pancreatitis
splenic hemangioma

A

chronic pancreatitis

51
Q

A patient presents with a history of fever and vomiting with increased serum levels of amylase and lipase. While scanning the abdomen you note a complicated cyst in the anterior pararenal space on the left side. These findings are most consistent with:

pancreatic pseudocyst
splenic aneurysm
GI tract mass
splenic varices

A

pancreatic pseudocyst

52
Q

Splenic torsion is most commonly associated with:

asplenia
accessory spleen
Gaucher disease
ectopic spleen

A

ectopic spleen

53
Q

Splenic vein thrombosis can lead to what life threatening condition?

GI bleed from gastric varices
CHF
splenic artery stenosis
splenic artery pseudoaneurysm

A

GI bleed from gastric varices

54
Q

Which of the following is a malignant splenic neoplasm?

hamartoma
granuloma
lymphoma
hemangioma

A

lymphoma

55
Q

Pseudoaneurysm formation, biliary obstruction and phlegmon are complications of:

alcoholic cirrhosis
insulinomas
pancreatitis
non-alcoholic steatosis

A

pancreatitis

56
Q

The most likely primary malignancy to metastasize to the spleen is ___. The most common malignancies that do metastasize to the spleen are ___.

breast cancer; melanoma and HCC
melanoma; lung and breast cancer
RCC; breast and thyroid adenocarcinoma
lung cancer; breast and parathyroid adenocarcinoma

A

melanoma; lung and breast cancer

57
Q

Which of the following is most commonly found in the pancreatic body or tail and secretes hormones?

islet cell tumor
microcystic cystadenoma
pseudocyst
macrocystic cystadenoma

A

islet cell tumor

58
Q

When a pancreas transplant has enteric drainage:

the urinary bladder should be evaluated for abnormalities

the allograft will be located in the chest

bowel should be evaluated for obstruction

it is common for the stomach to be dilated with pancreatic juices

A

bowel should be evaluated for obstruction

59
Q

Splenic atrophy in adults is often associated with:

tuberculosis
typhoid fever
splenitis
sickle cell anemia

A

sickle cell anemia

60
Q

Splenic calcifications are commonly seen with what type of infection?

parasitic
echinococcal
granulomatous
AIDS

A

granulomatous

61
Q

A patient presents with a recent diagnosis of AIDS. Which of the following statements is true regarding the sonographic appearance of spleen in this patient?

the spleen will be severely enlarged with numerous punctuate calcifications

the splenic hilum should be evaluated for varices

multiple hypoechoic tumors will be present causing marked increase in size

the spleen will be mild-moderately enlarged with a homogeneous texture

A

the spleen will be mild-moderately enlarged with a homogeneous texture

62
Q

Which of the following usually affects the pancreatic head?

adenocarcinoma and cystadenoma
focal pancreatitis and adenocarcinoma
pseudocyst and focal pancreatitis
cystadenoma and islet cell tumors

A

focal pancreatitis and adenocarcinoma

63
Q

What congenital anomaly of the pancreas results in duodenal obstruction?

pancreas divisum
aberrant pancreatic tissue
annular pancreas
pancreatic sequestation

A

annular pancreas

64
Q

Which of the following is a common cause of a splenic abscess?

endocarditis
PHTN
cholecystitis
Gaucher disease

A

endocarditis

**endocarditis, septicemia, and trauma are the most common causes of splenic abscess

endocarditis = infection of the lining of the heart and valves

65
Q

The X indicates what structure?

dilated CBD
dilated splenic vein
dilated duct of wirsung
dilated duct of santorini

A

dilated duct of wirsung

66
Q

Which of the following is an expected finding with asplenia?

liver on the right, GB on the left
presence of multiple spleens
IVC on the left side of the body
AO on the left side of the body

A

IVC on the left side of the body

67
Q

Which statement best describes the images displayed?

the mass in the pancreas is most likely pseudocyst because of the adjacent infection identified in the liver

the mass in the pancreas is most likely a pancreatic endocrine tumor because of the adenomas also identified in the adjacent liver

the mass in the pancreas is most likely thrombosis of the splenic vein because of portal branch thrombosis seen in the liver

the mass in the pancreas is most likely adenocarcinoma because of the metastasis identified in the liver

A

the mass in the pancreas is most likely adenocarcinoma because of the metastasis identified in the liver

68
Q

The splenic vein measures 5mm in diameter. If the diameter increases to 10mm with deep inspiration:

duodenal obstruction should be suspected
the celiac axis should be evaluated for obstruction
the response is normal
PHTN should be suspected

A

the response is normal

69
Q

Which of the following patients would most likely demonstrate a 10cm spleen with homogenous echotexture?

5’10” 250lb male born with homozygous sickle cell anemia

50 year old with splenic artery aneurysm

65 year old female with mononucleosis

30 year old female with lymphoma

A

50 year old with splenic artery aneurysm

70
Q

Which of the following is a common complication of cystic fibrosis?

renal calculi
AAA
PHTN
meconium ileus

A

meconium ileus

71
Q

Which of the following is an acquired abnormality of the spleen?

ectopic spleen
splenomegaly
splenunculi
agenesis

A

splenomegaly

72
Q

A splenic ___ is a cartilaginous tumor

chondroma
fibroma
hamartoma
osteoma

A

chondroma

73
Q

What causes pseudopancreatitis?

fatty liver
cholecystitis
polycystic liver disease
hepatitis

A

fatty liver

74
Q

A patient presents with a recent diagnosis of lymphoma. Which of the following is an expected finding on ultrasound?

multiple splenic varices at the hilum

multiple solid tumors are present causing marked increased in spleen size

solitary hyperechoic mass with peripheral hypervascularity

mildly enlarged spleen due to fluid accumulation

A

multiple solid tumors are present causing marked increased in spleen size

75
Q

Why does the spleen have increased risk of infarction compared to the other abdominal organs?

because there is only one intrasplenic artery

because the intrasplenic arteries do not have communicating branches

because of the small size of the splenic vein and increased risk of stasis thrombosis

because it is non-encapsulated

A

because the intrasplenic arteries do not have communicating branches

76
Q

What are the two most common causes of the abnormality displayed?

steroid and ibuprofen abuse
choledocholithiasis and alcoholism
hepatitis and cholecystitis
cirrhosis and gastric carcinoma

A

choledocholithiasis and alcoholism

77
Q

A patient presents with LUQ pain and no lab findings. He had a splenectomy 4 years ago after a car accident. There are 2 homogenous masses with smooth borders measuring <3cm located lateral and anterior to the pancreas tail. Internal vascularity is identified. These findings are most suggestive of:

splenosis
circumscribed hematomas
abscess formation
lymphatic adenopathy

A

splenosis

78
Q

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

amylase and lipase will be increased
pancreas is decreased in size and echogenicity
pancreas is increased in size and echogenicity
amylase levels will be increased, lipase levels will be decreased

A

amylase and lipase will be increased

79
Q

Chronic infection in soft tissue organs typically leads to:

the development of cavernous transformation

there is a small bowel obstruction at the duodenum resulting in fecalith formation around the head of the pancreas

the development of systemic HTN

the formation of calcifications

A

the formation of calcifications

80
Q

What is the most common abdominal lesion seen with Von Hippel Landau syndrome?

fatty liver sparing
pancreatic cysts
liver adenoma
RCC

A

pancreatic cysts

81
Q

If a peripheral, wedge-shaped, hypoechoic lesion is identified in the spleen, what should be the first diagnosis considered?

hamartoma
tuberculosis
Hodgkin lymphoma
infarction

A

infarction

82
Q

Which of the following splenic tumors is associated with tuberous sclerosis of Wiskott-Aldrich syndrome?

chrondroma
hamartoma
hemangioma
cystic lymphangioma

A

hamartoma

83
Q

Which of the following describes the sonographic appearance of acute pancreatic allograft rejection?

small atrophied gland with numerous cysts within the parenchyma

high resistance flow in the transplant arteries with numerous calcifications within the parenchyma

high resistance flow in the transplant arteries and heterogeneous appearance of the gland

small atrophied gland with numerous calcifications within the parenchyma

A

high resistance flow in the transplant arteries and heterogeneous appearance of the gland

84
Q

A 56 year old male presents with epigastric pain, nausea and a chronic history of alcoholism. Lab values demonstrate increased levels of amylase and lipase. Hematocrit levels are below normal values. The US exam demonstrates a hypoechoic, enlarged pancreas with perpendicular fluid. Which of the following best describes the findings?

phlegmon
acute pancreatitis
hemorrhagic pancreatitis
chronic pancreatitis

A

hemorrhagic pancreatitis

85
Q

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

there is a cyst in the posterior left lobe of the liver

there is a simple cyst in the body of the pancreas

there is a septated cyst in the tail of the pancreas

the SMA is dilated to a size similar to the AO

A

there is a simple cyst in the body of the pancreas

86
Q

All of the following are associated with gastrinoma formation in the pancreas EXCEPT:

symptoms include indigestion and esophageal reflux

significantly decreased levels of amylase production

associated with Zollinger-Ellison syndrome

increased serum levels of gastrin

A

significantly decreased levels of amylase production

87
Q

Which of the following statements is true regarding pancreatic masses?

a pancreatic tail mass is commonly mistaken for a mass in the caudate lobe

a round mass with smooth borders is usually a malignant process

the location of a mass in the head of the pancreas usually indicates a malignant process

the location of a mass in the tail of the pancreas usually indicates a malignant process

A

the location of a mass in the head of the pancreas usually indicates a malignant process

88
Q

Congestive splenomegaly is an expected finding in patients with:

ADPKD
CHF and splenic thrombosis
multicystic kidney disease
lymphoma and leukemia

A

CHF and splenic thrombosis

**congestive splenomegaly (Banti syndrome) caused by excessive pooling of blood in the splenic tissues - caused by PHTN, CHF or splenic thrombosis

89
Q

Which of the following results from embryonic failure of fusion of the pancreas tissues?

annular pancreas
pancreas divisum
ectopic pancreas tissue
Whipple pancreas

A

pancreas divisum

90
Q

A patient suffers from multiple endocrine neoplasm syndrome. The findings on the image are most suggestive of:

islet cell tumor
cystadenocarcinoma
lymphoma
pheochromocytoma

A

islet cell tumor

91
Q

What are the two most common infections that cause granuloma formation in the spleen?

mononucleosis and syphilis
colitis and cholecystitis
tuberous sclerosis and mononucleosis
tuberculosis and histoplasmosis

A

tuberculosis and histoplasmosis

92
Q

The bright band sign is a characteristic of:

splenic infarction
biliary tree dilatation
rectus abdominis hematoma
hepatitis

A

splenic infarction

93
Q

Gastrinomas are the most common islet cell tumor seen with:

Epstein Barr syndrome
MEN syndrome
cystic fibrosis
Kasabach-Merritt syndrome

A

MEN syndrome

94
Q

Which of the following correctly describes Non-Hodgkin lymphoma?

more commonly affects lymph nodes in the arms, upper chest and neck

average patient age 20 years old

usually affects the retroaortic and pelvic lymph nodes first

much less responsive to treatment than Hodgkin type

A

much less responsive to treatment than Hodgkin type

**most common type
average patient age 60 years old
occurs in any lymph nodes throughout the body

95
Q

Splenosis is a complication of:

PHTN
splenic infection
splenic trauma
sickle cell anemia

A

splenic trauma

ARDMS ABD REVIEW (27 decks)

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