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ABD Final

Total questions: 90

Worksheet time: 47mins

Name
Class
Date
1.

What are ultrasound contrast agents (UCAs) primarily used for?

a)

To eliminate aliasing during scanning

b)

To reduce ultrasound system mechanical index

c)

To improve sensitivity and specificity in ultrasound diagnosis

d)

To eliminate the need for Doppler imaging

2.

Harmonic imaging works by:

a)

Transmitting at 2 different frequencies

b)

Accepting only harmonic frequencies returning from tissue

c)

Eliminating the use of Doppler imaging

d)

Ignoring microbubble signals

3.

How can we avoid destroying microbubbles during contrast imaging?

a)

Increase the MI to >1.0

b)

Use a high-frequency transducer

c)

Reduce the MI to <0.2

d)

Increase power Doppler sensitivity

4.

Which of the following is a contraindication for an ultrasound-guided procedure?

a)

Patient refuses to consent

b)

Patient has a history of gallstones

c)

Patient has mildly elevated LFTs

d)

Patient has abdominal tenderness

5.

What is the purpose of a core biopsy?

a)

To obtain tissue

b)

To obtain cells

c)

To obtain fluid

d)

To obtain muscle

6.

What is the purpose of a Fine Needle Aspiration?

a)

To obtain cells

b)

To obtain tissue

c)

To obtain fluid

d)

To obtain muscle

7.

What are the advantages of using ultrasound guidance during a procedure?

a)

Better visualization

b)

Prevent puncture/ damage to vital organs

c)

Slower process which improves accuracy

d)

Enables various patient positions and angles

e)

Portabillity

8.

Select what could cause an inconclusive result during a procedure:

a)

Insufficent sample

b)

Patient movement

c)

Overlying structures

d)

Adequate imaging window

e)

Proper positioning

9.

The most common cause of needle deviation during a procedure is:

a)

Patient breathing

b)

Tissue type needle passes through

c)

Incorrect probe selection

d)

Excessive gel use

10.

Select the order of steps for an ultrasound guided procedure:

a)

  1. 1.Review history

  2. 2. Consent

  3. 3. Vitals

  4. 4. Ultrasound for location & approach

  5. 5. Procedure is performed

  6. 6. Vitals, pain level assessment, equipment disinfected

  7. 7. Patient taken to recovery

b)

  1. 1.Consent

  2. 2. History

  3. 3.Vitals

  4. 4. Procedure

  5. 5. Ultrasound for location & approach

  6. 6. Patient taken to recovery

  7. 7. Vitals, pain level assessment, equipment disinfected

c)

1. Vitals

  1. 2. Review history

  2. 3. Consent

  3. 4. Ultrasound for location & approach

  4. 5. Procedure

  5. 6. Patient taken to recovery

    1. 7. Vitals, pain level assessment, equipment disinfected

d)

  1. 1. Review history

  2. 2. Vitals

  3. 3. Consent

  4. 4. Ultrasound for location & approach

  5. 5. Procedure

  6. 6. Vitals, pain level assessment, equipment disinfected

  7. 7. Patient taken to recovery

11.

What is a gastric bezoar

a)

A congenital cyst of the stomach

b)

A mass of indigestible material in the stomach

c)

A type of stomach polyp

d)

A malignant gastric tumor

12.

Phytobezoar

a)

Made of plant fibers

b)

Made of hair

c)

Made of inorganic materials

13.

Trichobezoar

a)

Made of plant fibers

b)

Made of hair

c)

Made of inorganic materials

14.

Concretions

a)

Made of plant fibers

b)

Made of hair

c)

Made of inorganic materials

15.

What is the normal echogenicity of the spleen?

a)

Isoechoic compared to the liver

b)

Isoechoic or slightly hypoechoic to the renal cortex

c)

Anechoic compared to the liver

d)

Homogenous texture, slightly more echogenic than the liver

16.

Crohn’s disease most commonly affects the:

a)

Duodenum

b)

Terminal ileum and/or colon

c)

Gallbladder

d)

Pancreatic head

17.

A leiomyosarcoma is:

a)

A benign gastric polyp

b)

A smooth muscle tumor

c)

An inflammatory bowel tumor

d)

Inflammation of the gallbladder

18.

Pseudomyxoma peritonei is caused by:

a)

Accumulation of gas in the peritoneal cavity

b)

Mucinous material spreading from a ruptured mucin-producing tumor

c)

Fatty infiltration of peritoneal tissues

d)

Chronic ascites

19.

Contrast enhanced ultrasound can differentiate benign vs malignant lesions with what accuracy?

a)

60%

b)

75%

c)

90%

d)

100%

20.

Bilirubin is formed by:

a)

Breakdown of proteins

b)

Breakdown of RBCs

c)

Breakdown of lipids

d)

Breakdown of glycogen

21.

What describes portal veins?

a)

Echogenic walls, course horizontally, hepatopetal flow (towards the liver)

b)

Thin, anechoic walls, course vertically, hepatofugal flow (away from liver)

c)

Echogenic walls, course vertically, hepatofugal flow (away from liver)

d)

Thin, anechoic walls, course horizontally, hepatpetal flow (towards the liver)

22.

Describe hepatic veins:

a)

Thin, anechoic walls

b)

Course vertically

c)

Course horizontally

d)

Hepatopetal flow

e)

Hepatofugal flow

23.

The main portal vein is formed by the convergence of:

a)

Hepatic veins and the splenic vein

b)

Splenic vein and the SMV

c)

IMV and renal vein

d)

IVC and splenic vein

24.

Morrison’s pouch is located between the:

a)

Liver and diaphragm

b)

Liver and Right Kidney

c)

Stomach and spleen

d)

Portal vein and IVC

25.

Glisson’s capsule is:

a)

The fibrous covering of the spleen

b)

The connective tissue surrounding the liver and portal triad

c)

The gallbladder wall

d)

The capsule of the pancreas

26.

Fatty infiltration of the liver is most often caused by:

a)

Obesity and alcohol intake

b)

Gallstones

c)

Appendicitis

d)

Viral pneumonia

27.

Select what describes fatty infiltration :

a)

Lack of lipids within liver cells

b)

Acquired, reversible, and benign condition

c)

Acquired, irreversible, and malignant condition

d)

Increased accumulation of lipids within liver cells

28.

Which of the following is NOT a sign of acute pancreatitis?

a)

Severe epigastric pain

b)

Nausea and vomitting

c)

Jaundice

d)

Hypotension

29.

Which structure divides the liver into right and left lobes?

a)

Ligamentum teres

b)

Falciform ligament

c)

Hepatic veins

d)

Main lobar fissure

30.

Amylase is responsible for breaking down:

a)

Proteins

b)

Starch and glycogen into simple sugars

c)

Lipids

d)

Hemoglobin

31.

Select the risk factors for pancreatic carcinoma:

a)

White, females ,diet, smoking, family history, chronic pancreatitis, older than 60

b)

Black, male, diet, smoking, family history, chronic pancreatitis, older than 60

c)

Black, women, diet, smoking, acute pancreatitis, under 60

d)

Black, male, smoking, family history, acute pancreatitis , under 60

32.

Glucagon functions to:

a)

Lower blood sugar

b)

Raise blood sugar

c)

Breakdown proteins

d)

Stimulate bile production

33.

The most commonly used tumor marker for hepatocellular carcinoma (HCC) is:

a)

ALT

b)

AFP

c)

AST

d)

Amylase

34.

Which landmark helps identify the caudate lobe of the liver?

a)

Ligamentum venosum and IVC

b)

Falciform ligament and IVC

c)

Portal vein and Hepatic Artery

d)

Galbladder fossa and RLL

35.

An amoebic abscess of the liver is usually caused by:

a)

Viral hepatitis

b)

Intestinal amoebiasis spreading via portal vein

c)

Galbladder stones

d)

Pancreatic carcinoma

36.

The ligamentum teres is the remnant of which fetal structure?

a)

Umbilical artery

b)

Umbilical vein

c)

Ductus venosus

d)

Foramen ovale

37.

Why do we take an intercostal image of the main portal vein?

a)

Avoid obstruction from overlying bowel gas

b)

To avoid the ribs

c)

To measure better

d)

Better vertical view

38.

What is the ultrasound appearance of a cavernous hemangioma

a)

Hyperechoic if <3cm, mixed echogenicity if larger

b)

Hypoechoic if <3cm, Hyperechoic if larger

c)

Hyperechoic if >3cm, mixed echogenicity if smaller

d)

Hypoechoic if >3cm, mixed echogenicity if smaller

39.

What connects the GB and PV on ultrasound

a)

Hepatic artery

b)

Main Lobar Fissure

c)

Splenic vein

d)

Ligamentum Teres

40.

Which vessels make up the portal triad?

a)

Hepatic vein, Splenic vein, CBD

b)

Hepatic artery, Portal vein, CBD

c)

IVC, Hepatic artery, Hepatic Vein

d)

Hepatic vein, CBD, Splenic vein

41.

Which direction should blood flow in the portal vein?

a)

Hepatopetal

b)

Hepatofugal

c)

Bidirectional

d)

Turbulent

42.

How does the Right Hepatic vein divide the liver

a)

Anterior and posterior segments

b)

Medial and lateral segments

c)

Superior and inferior segments

d)

RLL from LLL

43.

How does the Main Hepatic vein divide the liver?

a)

Anterior and posterior segments

b)

RLL from LLL

c)

Medial and lateral segments

d)

Superior and inferior segments

44.

How does the Left Hepatic vein divide the liver

a)

Medial and lateral segments

b)

Anterior and posterior segments

c)

RLL and LLL

d)

Superior and inferior segments

45.

How does the portal vein divide the liver

a)

Superior and inferior segments

b)

Medial and lateral segments

c)

Anterior and posterior segments

d)

RLL from LLL

46.

Which segment is the caudate lobe

a)

I

b)

II

c)

IV

d)

III

47.

Which lobes are the Superior and Inferior lateral left lobe

a)

II & III

b)

IV A & IV B

c)

V & VI

d)

VI & VII

48.

Which lobes are the Superior and Inferior medial left lobes

a)

IV A & IV B

b)

I & II

c)

II & III

d)

VI & VII

49.

Which lobes are the anterior and posterior inferior right lobes?

a)

V & VI

b)

VII & VIII

c)

II & III

d)

III & IV

50.

Which lobes are the posterior and anterior superior right lobes?

a)

VII & VIII

b)

VI & VII

c)

II & III

d)

IV A & IV B

51.

The “starry sky” appearance on ultrasound is most associated with:

a)

Cirrhosis

b)

Acute hepatitis

c)

Fatty infiltration

d)

Hemangioma

52.

Porcelain gallbladder refers to:

a)

A calcified gallbladder wall

b)

A gallbladder full of sludge

c)

A contracted gallbladder

d)

Gallstones with posterior enhancement

53.

Select what describes the ultrasound appearance of fatty infiltration:

a)

Increased echogenicity of the liver

b)

Hepatomegaly

c)

Hypoechoic compared to the kidneys

d)

Hyperechoic compared to the kidneys

e)

Poor visualization of vessels

54.

What is the ultrasound sign associated with choledochal cysts?

a)

Shotgun sign

b)

Starry night

c)

Bullseye sign

d)

Ductal dilation

55.

Which liver pathology is associated with oral contraceptive use?

a)

Cavernous hemangioma

b)

Hepatocellular adenoma

c)

Cirrhosis

d)

Hepatic cyst

56.

Which lab value is most associated with bile duct obstruction?

a)

ALT

b)

AST

c)

ALP

d)

AFP

57.

Which is indicative of portal hypertension in adults?

a)

Dilation >13mm

b)

Dilation >15mm

c)

Dilation >1.3 mm

d)

Dilation >13 cm

58.

What ultrasound sign is associated with choledochal cysts?

a)

Target sign

b)

Shotgun sign

c)

Starry sky sign

d)

WES sign

59.

What is the ultrasound appearance of a TIPS shunt?

a)

Cystic, round mass in the liver

b)

Echogenic, linear structure in liver parenchyma

c)

Anechoic fluid collection

d)

Dilated bile duct

60.

Hepatic candidiasis typically appears as:

a)

Calcified nodules in the liver

b)

Multiple bullseye or target-like lesions

c)

Hyperechoic solid mass

d)

Anechoic cysts

61.

Acinar cells of the pancreas perform what function?

a)

Endocrine- insulin secretion

b)

Exocrine- digestive enzyme secretion

c)

Store bile salts

d)

Detoxify blood

62.

In a sagittal view of the pancreas, which blood vessel should you see open fully in a horizontal plane?

a)

Portal vein

b)

Splenic vein

c)

IVC

d)

Left Renal vein

63.

Islets of Langerhans in the pancreas function to:

a)

Digest carbohydrates

b)

Perform endocrine functions regulating blood glucose

c)

Excrete bile

d)

Store pancreatic enzymes

64.

A pancreatic head mass most commonly causes:

a)

Splenic rupture

b)

Compression of the CBD with proximal bile duct dilation

c)

Portal vein thrombosis

d)

Compression of the Splenic Vein with proximal dilation

65.

The main pancreatic duct is also called:

a)

Duct of Santorini

b)

Duct of Wirsung

c)

Cystic Duct

66.

The accessory pancreatic duct is called:

a)

Duct of Santorini

b)

Duct of Wirsung

c)

Cystic duct

67.

The most common gallbladder variant is:

a)

Phrygian cap

b)

Junctional fold

c)

Septate gallbladder

d)

Sludge-filled gallbladder

68.

The WES sign (Wall Echo Shadow) indicates:

a)

Acute hepatitis

b)

Gallbladder stones

c)

Biliary sludge

d)

Portal hypertension

69.

Adenomyomatosis of the gallbladder is:

a)

Malignant tumor of GB

b)

Benign proliferation of the GB wall tissue

c)

Inflammation of GB

d)

Calcification of GB wall

70.

A Klatskin tumor is located:

a)

At junction of right and left hepatic ducts

b)

In the pancreatic tail

c)

In the GB neck

d)

Within the portal vein

71.

The proximal and distal ends of the biliary tree are:

a)

Proximal= intrahepatic ducts

Distal = Ampulla of Vater

b)

Proximal = Ampulla of Vater

Distal =Intrahepatic ducts

c)

Proximal = Cystic duct

Distal = Main portal vein

d)

Proximal = Hepatic vein

Distal =Intrahepatic ducts

72.

On ultrasound, cholelithiasis (gallstones) appear as:

a)

Hypoechoic round lesions without shadowing with no mobility

b)

Echogenic mass with posterior acoustic shadowing that move with position change

c)

Anechoic structures with no mobility

d)

Hyperechoic structures with no shadowing that move with position change

73.

What is a phrygian cap?

a)

A fold of the GB fundus over the body

b)

A septated GB wall

c)

A fold of the GB body over the neck

d)

A junction between the neck and fundus of the GB

74.

Valves of Heister are found in the:

a)

CBD

b)

Cystic Duct

c)

Hepatic ducts

75.

Pneumobilia on ultrasound appears as:

a)

Hypoechoic rounded cysts in bile ducts

b)

Bright echogenic foci with dirty shadowing and ring-down artifact

c)

Dilated bile ducts with anechoic fluid

d)

Sludge balls

76.

White pulp of the spleen is primarily composed of:

a)

Red blood cells

b)

Lymphatic follicles and immune cells

c)

Macrophages only

77.

Red pulp of the spleen is composed of:

a)

Lymphocytes and macrophages

b)

Red blood cells

c)

Lymphatic follicles

d)

Malpighian corpsucles

78.

An ectopic spleen is also called a:

a)

Wandering spleen

b)

Accessory spleen

c)

Splenic infarct

d)

Splenic torsion

79.

Pancreatic phlegmon is:

a)

Malignant tumor

b)

Localized inflammatory process of pancreas

c)

Calcified cyst

d)

Splenic torsion

80.

The “starry sky” ultrasound sign may be seen with:

a)

Pneumocystis infection

b)

Acute hepatitis

c)

Cirrhosis

d)

GB carcinoma

81.

Elevated white blood cells are referred to as:

a)

Leukopenia

b)

Leukocytosis

c)

Anemia

d)

Polycythemia

82.

What might be the cause of a splenic infarct?

a)

Intrasplenic arterial branches do not anastomose (communicate)

b)

Venous drainage is excessive

c)

Collateral vessels enlarge

d)

Increased portal hypertension

83.

Splenic torsion most often occurs due to:

a)

Splenomegaly

b)

Wandering spleen with lack of normal attachments

c)

Trauma

d)

Cirrhosis

84.

Angiosarcoma of the spleen is:

a)

Benign splenic tumor

b)

Rare malignant tumor often metastasizing to the liver

c)

Simple cyst

d)

Hematoma

85.

The greater omentum serves what purpose?

a)

Prevents liver enlargement

b)

Cushions abdominal organs and moves to sites of inflammation

c)

Stores pancreatic enzymes

d)

Anchors gallbladder to liver

86.

Ultrasound signs of biliary obstruction include:

a)

Shotgun sign, too many tubes sign

b)

Starry sky sign

c)

Tip of iceberg sign

d)

Bullseye sign

87.

Paracentesis drains fluid from the:

a)

Chest cavity

b)

Abdominal cavity

c)

Gallbladder

d)

Liver

88.

Which ligaments attach the spleen to adjacent organs?

a)

Splenorenal to the left kidney

Gastrosplenic to the stomach

b)

Splenorenal to the stomach

Gastrosplenic to the left kidney

c)

Portal to the kidney

Hepatic to the liver

d)

Round ligament and the Falciform ligament

89.

Budd-Chiari syndrome is caused by:

a)

Thrombosis or narrowing of hepatic veins blocking outflow

b)

Pancreatic head carcinoma

c)

Splenic rupture

d)

Portal vein thrombosis

90.

Where is the appendix usually found in the body?

a)

RUQ near liver

b)

RLQ near McBurney's point

c)

LUQ near spleen

d)

LLQ near McBurneys point