DMSU 210 Final Exam Prep | Complete Solutions (Verified Answers)

DMSU 210 Final Exam Prep | Complete Solutions (Verified Answers) A gallbladder with multiple septate, multiple polyps, and comet-tail artifact on sonography is consistent with: Adenomyomatosis Which of the following is NOT characteristic of gallstones? posterior enhancement The sonographic WES sign is characteristic of: a gallbladder that is completely filled with stones A 68-year-old woman has right upper quadrant pain. The ultrasound examination reveals a distended gallbladder with a wall thickness of 1.8 mm. The gallbladder contains low-level echoes that layer and are gravity dependent and multiple small echogenic foci that shadow (Figure 2, A and B). The common bile duct measures 10 mm and also contains a small echogenic focus (Figure 2, C) in its distal aspect. What is the most likely diagnosis? All of the above; choledocholithiasis, sludge, and cholelithiasis A 45-year-old man has epigastric pain of 3 week's duration. A right upper quadrant ultrasound scan reveals multiple small polypoid lesions that arise from the gallbladder wall. The remaining ultrasound examination results are unremarkable. Subsequent investigation of the gastrointestinal tract reveals gastroenteritis. What is the most likely diagnosis for the finding in the gallbladder? Gastritis Optimal imaging of the gallbladder generally requires a _____ frequency than that used to evaluate the right lobe of the liver. Higher A 49-year-old woman is seen at an emergency department with epigastric pain for 1 day, nausea and vomiting, and an elevated temperature. The ultrasound examination reveals a thick-walled gallbladder and evidence of gallstones (Figure 3, A and B). What is the most likely diagnosis? acute cholecystitis A 36-year-old man is seen with right upper quadrant pain, diarrhea, and fever. History reveals that the patient recently returned from a 2-week business trip in South America. An ultrasound examination of the right upper quadrant reveals a 3 cm mass in the right lobe of the liver that appears to be isoechoic to the liver, with a surrounding hypoechoic halo. Acoustic enhancement posterior to the mass is also shown (Figure 4, A and B). What is the most likely diagnosis? amoebic abscess Which of the following is NOT characteristic of hepatic abscess? Hypoechoic mass with thick wall and posterior enhancement Multiple small masses with echogenic centers Mass with echogenic foci and dirty shadowing in subhepatic space NONE of the above What is the upper limit of normal gallbladder wall thickness if the patient is fasting? 3 mm Which of the following sonographic characteristics is consistent with pyelonephritis? Normal-looking kidney Focal hypoechoic area in renal parenchyma Renal stones all of the above Multiple patient positions are important when scanning the gallbladder because: Gallstones are mobile. Bowel can move out of the way. The gallbladder moves when the patient moves. all of the above Elevation of which of the following laboratory values is most associated with biliary obstruction? alkaline phosphatase A 64-year-old man undergoes an ultrasound scan for right-sided pain to rule out gallbladder disease. The patient also has a history of autosomal dominant polycystic kidney disease and bilateral nephrectomy. Ultrasound examination of the right upper quadrant reveals a normal gallbladder and multiple thin-walled anechoic structures within the liver (Figure 5). These results are most consistent with what diagnosis? polycystic disease of the liver Low-level "sandy" echoes within the gallbladder that move when the patient changes position but do not exhibit shadowing are consistent with: gallbladder sludge The initial test in a patient with cholestasis should be: liver ultrasound The Doppler waveform in the image above is consistent with: hepatic vein The most common cause of hepatocellular disease in the United States is: alcoholic liver disease The chronic hallmark of cholestasis is the presence of ascites. False A term that means brain disease, damage, or malfunction Encephalopathy Hepatic veins are easily distinguished from portal veins because: portal veins are surrounded by an echogenic wall Which of the following is NOT a cause of jaundice? Hemochromatosis What is the most likely differential disease represented in this case study? steatosis: fatty infiltration What is the most likely differential disease represented in this case study? passive liver congestion Another term for acute: Sudden AST and ALT elevations are indicative of hepatocellular injury True The "too many tubes" sign is associated with: biliary obstruction A condition in which the blood's ability to clot is impaired (clotting disorder) Coagulopathy Urge to scratch; itching Pruritus The two main patterns of liver injury are: hepatocellular and cholestatic An enlarged, echogenic liver with coarse echo texture is characteristic of: acute hepatitis Standard workup for acute hepatitis includes all of the following, except: liver biopsy Bilirubin can be elevated in both cholestatic and hepatocellular processes True What is the most likely differential disease represented in this case study? Hepatitis The liver parenchyma is composed of hepatocytes. The major supporting cells are ______________________________. Kupffer The following statements are all true, except: blood flow to the liver is only through the hepatic artery Chronic viral hepatitis is caused by all of the following except: TIPS shunt Which of the following conditions is demonstrated in the image above? portal vein thrombosis An atrophic, echogenic liver with nodular borders accompanied by splenomegaly is characteristic of: chronic hepatitis Increased pressure in the portal vein can be a consequence of: A & C; liver fibrosis and vein obstruction An obstruction of the cystic duct is associated with: Mirizzi syndrome An increase from the baseline ALT/AST levels in patients with chronic hepatocellular injury should prompt investigation to exclude a new hepatic insult. True Which of the following is NOT characteristic of portal veins? hepatofugal flow Which of the following is characteristic of hepatic veins? run between liver segments Irregular lapses of posture Asterixis The head of the pancreas is inferior to the _____________ of the liver: caudate lobe The splenic artery is considered to be along the _________________ border of the pancreas. Superior A condition that causes increased secretion of abnormal mucus by the exocrine glands is: cystic fibrosis The primary pancreatic duct is the duct of ______________. Wirsung The splenic vein courses along the ____________________ of the pancreas. posteromedial border The ___________ passes through a groove posterior to the pancreatic head. CBD A common course of enzyme destruction via the pancreas is the accumulation in the: lesser sac The duct of Santorini is a(n): accessory duct to the pancreas A patient with painless jaundice, weight loss, and a decrease in appetite should be evaluated for: adenocarcinoma of the pancreas Gallstones are present in 40% to 60% of patients with: acute pancreatitis The microscopic collection of cells within the tissues of the pancreas is called? islets of langerhans The key to identifying pancreatic anatomy is: vascular landmarks The head of the pancreas lies: medial to the duodenum If the celiac axis is well visualized, the sonographer should move the transducer in the __________ direction to image the pancreas? inferior Clinical signs and symptoms in acute pancreatitis include all of the following except: severe abdominal pain radiating to the right shoulder A most common cause of acute pancreatitis in the United States is: biliary tract disease Which one of the following structures is located in the anterolateral border of the pancreas? gastroduodenal artery The main pancreatic duct joins the __________ before entering the second part of the duodenum. CBD The persistence of the dorsal and ventral pancreas with the head encircling the duodenum is called: annular pancreas In cases of acute pancreatitis, the parenchyma of the pancreas generally appears: Hypoechoic What vessel runs posterior to the lower neck of the pancreas and anterior to the uncinate process? superior mesenteric vein The pancreas is reflective in its sonographic appearance because of the multiple: fat between the lobules The normal size of the pancreatic duct is less than _____ mm. 3 The majority of the pancreas lies within which abdominal cavity? Intraperitoneal The pancreas is found behind the ___________ omental sac. lesser The normal dimension of the pancreatic head is usually less than ___________. 2 cm A serum _____ level of twice normal usually indicates acute pancreatitis. Amylase An older man with a history of alcoholism is recently diagnosed with acute pancreatitis. His hematocrit and hypotension levels are decreased. Your differential diagnosis includes: hemorrhagic pancreatitis The tail of the pancreas is located: anterior to the left kidney, near the splenic hilum Which one of the following statements is false? the head of the pancreas is superior to the caudate lobe _____ is the most common problem encountered when attempting to visualize the pancreas. overlying bowel gas _____ is an inflammation that often results in abscess formation that extends beyond the borders of the pancreas. Phlegmon A 50-year-old man with chronic epigastric pain and nausea and vomiting is seen by his physician. The patient is a Vietnam war veteran with many years of alcohol abuse who has had recent weight loss, malaise, and loss of appetite. The ultrasound examination reveals a hyperechoic, heterogeneous pancreas with a pancreatic duct that measures 0.7 cm. Also noted is a round 2 cm echogenic structure with posterior shadowing within the body/tail region of the pancreas. What is the most likely diagnosis? chronic pancreatitis Which of the following is NOT consistent with the typical sonographic appearance of chronic pancreatitis? diffusely hypoechoic pancreas A 31-year-old man is seen in the emergency department with severe midepigastric pain that radiates to his back and with nausea and vomiting that came on suddenly with a fever 24 hours previously. The laboratory blood work results show an elevated white blood cell count, moderately elevated amylase level, and mildly elevated lipase. With further questioning, the patient admits to an alcoholic binge with old college buddies 2 days ago. An ultrasound examination of the upper abdomen reveals an irregular hypoechoic region in the tail of the pancreas. What is the likely diagnosis? acute focal pancreatitis _____ sign is a bruising discoloration of the flanks areas of the abdomen seen with hemorrhagic pancreatitis. grey-turner Which of the following complications of acute pancreatitis is frequently fatal? Hemorrhagic pancreatitis Phlegmonous pancreatitis Ruptured pseudocyst All of the above None of the above Which portion of the pancreas is usually most superior? Tail The main pancreatic duct is the _____. duct of wirsung Which of the following is a common location of pancreatic carcinoma metastasis? A & B; liver & periaortic lymph nodes Which of the following is the most common cause of acute pancreatitis in the United States? biliary obstruction A _____ is a collection of pancreatic enzymes and body fluid in a cyst-like loculus but without an epithelial lining. pancreatic pseudocyst Which of the following is the most common cause of chronic pancreatitis in the United States? alcohol abuse Which of the following is NOT consistent with the sonographic appearance of acute pancreatitis? echogenic pancreas Which part of the pancreas has the largest AP dimension? Head Which of the following is NOT consistent with acute pancreatitis? Leukopenia Which of the following is NOT a common cause of biliary ductal and pancreatic ductal dilatation? pancreatic tail mass Which of the following is NOT a cause of pancreatitis? Damage to the acini cells of the pancreas Leakage of pancreatic enzymes Blunt abdominal trauma none of the above The Duct of Wirsung joins the _____ at the ______and enters the duodenum. CBD, ampulla of vater _____ is used to create the "twinkle artifact" characteristic of renal calculi. color doppler The normal adult urethra is approximately: 20 cm long in males A 65-year-old patient with a history of abdominal pain and gas is seen for an abdominal and pelvic ultrasound scan. The laboratory results included hematuria. Ultrasound examination of the abdomen reveals a slightly enlarged spleen and a solid right renal upper pole mass (Figure 1,A and B). No hydronephrosis is identified, and the right renal vein and inferior vena cava are patent. A computed tomographic (CT) scan is performed to further evaluate the right renal mass. What is the most likely differential consideration? renal cell carcinoma Cystitis is: infection of the bladder wall The image above is consistent with: Nephrocalcinosis Bladder pathology includes all EXCEPT: Nephrocalcinosis Normal adult bladder wall thickness is: 3 mm when distended Autosomal dominant polycystic kidney disease may be characterized by all of the following statements except: the kidneys are small and extremely echogenic The kidneys are located in the: retroperitoneal cavity A common finding in people over 50 years of age is: renal cyst A cystlike enlargement of the distal end of the ureter is called a: Ureterocele The process of disposing metabolic wastes is called: Excretion A cortical bulge in the lateral border of the kidney is called a(n): dromedary hump An extremely large echogenic renal sinus that appears to engulf the entire renal parenchymal outline suggests: Lipomatosis The most common location of renal ectopia is the: Pelvis A common benign vascular fatty tumor of the kidney is called a(n): Angiomyolipoma A triangular-shaped defect located anteriorly in the upper pole of the kidney most likely represents a(n): junctional parenchymal defect The left renal vein courses: anterior to the aorta The most common solid renal mass found in childhood is: wilms' tumor Renal cell carcinoma commonly invades the IVC via the: renal vein Papillary necrosis may develop within ________ after renal transplantation. weeks or months Which one of the following describes the sonographic appearance of chronic pyelonephritis? inability to distinguish the cortex from the medullary regions Pyonephrosis refers to the presence of: pus in a dilated collecting system Renal stone formation is mostly likely in all EXCEPT: intraperitoneal kidneys Reddish urine, caused by a breakdown of muscle is: Myoglobinuria Renal calculi shadowing can usually be seen with stones as small as: 3 to 4 mm The action or process of draining or losing blood. Exsanguination A 58-year-old man is seen for ultrasound scan of the aorta because of a pulsatile mass over the area of the umbilicus on physical examination. The distal aorta is shown in Figure 2, A and B. What is the most likely diagnosis? abdominal aortic dissection Arises from the anterior aortic wall at the level of the third or fourth lumbar vertebra to supply the left transverse colon, descending colon, sigmoid colon, and rectum inferior mesenteric artery Which vessel lies posterior to the bile duct and anterior to the portal vein? hepatic artery A 79-year-old woman is seen for ultrasound scan of the aorta after multiple episodes of fainting. She has a history of poorly controlled hypertension and aneurysm and also has back pain. The ultrasound examination is technically limited because of obesity. The ultrasound findings confirm a dilated aorta that measures 7 cm in AP diameter (Figure 4, A and B). A linear echo is also identified within the aorta, and color Doppler scan confirms flow on both sides of this flap. What is the most likely diagnosis? aortic dissection Tests are used to help rule out the presence of an inappropriate blood clot (thrombus). Some of the conditions that the D-dimer test is used to help rule out include: Deep vein thrombosis (DVT) Pulmonary embolism (PE) d-dimer Communication between an artery and a vein arteriovenous fistula Tiny arteries and veins that supply the walls of blood vessels vasa vasorum A mass of cells and fluid that has seeped out of blood vessels or an organ, especially in inflammation Exudate What could account for decreased pulsations of the abdominal aortic walls and hyperechoic aortic wall echoes? arteriosclerosis What instrumentation adjustment can help remove artifact echoes that may appear in the lumen of the abdominal aorta? decrease time gain compensation (TGC) Middle layer of the vascular system; veins have thinner tunica media than arteries tunica media What is the most common location of aneurysms associated with the continuation of an abdominal aortic aneurysm? iliac artery Arises inferior to the celiac axis to supply the proximal half of the colon and the small intestine superior mesenteric artery Minute vessels that connect the arterial and venous systems Capillaries An 82-year-old man arrives in the emergency department via ambulance from a nursing care facility. The patient is unconscious, and clinical examination reveals hypotension and an abdominal pulsatile mass. A portable ultrasound scan is requested immediately; examination reveals a dilated aorta that measures 8.5 cm in AP diameter (Figure 3). The findings and clinical examination suggest what diagnosis? ruptured aortic aneurysm In which vessel does an increase in blood flow occur after eating? superior mesenteric artery What is a common finding associated with vascular stenosis? poststenotic dilation Which term defines the inner wall layer of an artery and vein? tunica intima What state presents when the Doppler spectral analysis of the normal superior mesenteric artery demonstrates reduced or absent reversal of flow during the diastolic phase of the cardiac cycle concomitant with increased peak forward diastolic flow? postprandial state Circumferential dilation involving the entire aorta tapering at both ends fusiform aneurysm What type of pressure describes the normal venous system? Low An inflammation of the blood vessels that causes changes in the blood vessel walls Vasculitis An 82-year-old man is seen for follow-up examination of an abdominal aortic aneurysm. The ultrasound scan reveals a dilated distal aorta that measures 3.9 cm in AP diameter. Mural thrombus is shown with color Doppler scan (Figure 5). No increase in size is noted from the ultrasound scan performed 6 months before. What is the appropriate follow-up for this patient at this time? follow-ups every 6 months The leakage of intravenously (IV) infused potentially damaging medications into the extravascular tissue around the site of infusion. Extravasation Branch of the common hepatic artery that supplies the stomach and duodenum common hepatic artery Arises from the posterolateral wall of the aorta and travels posterior to the inferior vena cava to supply the kidney right renal artery