Ultrasound Games & Quizes & Exams

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Page 1 of 11Copyright 2012, 2006, 2001, 1995, 1989, 1983, 1978 by Mosby, an imprint of Elsevier Inc. Hagen: Textbook of Diagnostic Sonography, 7th Edition Chapter 10:

[size=34]The Liver Test Bank MULTIPLE CHOICE

1. The liver is suspended from the diaphragm and anterior abdominal wall by the:

a. Ligamentum teres
b. Falciform ligament
c. Round ligament
d. Triangular ligament

ANS: B
The falciform ligament extends from the umbilicus to the diaphragm.

2. Fatty infiltration may be observed in all patients except those with:
a. Diabetes mellitus
b. Chronic alcoholism
c. Hepatoportal fistula
d. Hepatitis

ANS: C
A common cause of fatty infiltration includes alcoholic liver disease, diabetes mellitus, obesity, pregnancy, severe hepatitis, chronic illness, and the use of steroids.

3. Sonographic findings of acute hepatitis include:

a. Accentuated brightness, more extensive demonstration of portal vein radicles, and an overall decreased echogenicity of liver
b. Decreased brightness and echogenicity of liver
c. Increased brightness and echogenicity of liver, and no demonstration of portal vein radicles
d. Ascites, decreased brightness, and echogenicity

ANS: A
In patients with acute hepatitis, the liver demonstrates accentuated brightness, more extensive demonstration of portal vein radicles, and an overall decrease in parenchyma echogenicity.

4. Budd-Chiari syndrome is a rare disorder caused by obstruction of the:
a. Portal veins
b. Superior mesenteric vein
c. Hepatic veins
d. Splenic vein

ANS: C
Budd-Chiari syndrome is an uncommon, often dramatic, illness caused by thrombosis of the hepatic veins or inferior vena cava (IVC

5. Echinococcal cysts have the highest incidence in countries in which:
a. Fishing is common.
b. Rock climbing is prevalent.
c. Poultry is abundant.
d. Sheep grazing is common.

ANS: D
Hepatic echinococcosis is an infectious cystic disease common in sheep-herding areas of the world.

6. The most common benign tumor of the liver is:
a. Mesenchymal hamartoma
b. Adenoma
c. Cavernous hemangioma
d. Infantile hemangioendothelioma

ANS: C
The cavernous hemangioma is the most common benign tumor of the liver.

7. What benign liver tumor has been found in patients with type I glycogen storage disease?
a. Lipoma
b. Adenoma
c. Cavernous hemangioma
d. Hamartoma

ANS: B
Glycogen storage disease is associated with adenomas, focal nodular hyperplasia, and hepatomegaly.

8. Patients who have hepatocellular carcinoma are likely to have had:
a. Hemochromatosis
b. Adenosis
c. Cirrhosis
d. Carcinosis

ANS: C
Eighty percent (80%) of patients with preexisting cirrhosis develop hepatocellular carcinoma.

9. The most common form of neoplastic involvement of the liver is:
a. Metastases
b. Hepatocellular carcinoma
c. Hepatoma
d. Hamartoma

ANS: A
Metastatic disease is the most common form of neoplastic involvement of the liver.
Primary sites include the colon, breast, and lung.
Metastasis to the liver occurs as the tumor erodes the wall and travels through the lymphatic system or through the bloodstream to the portal vein or hepatic artery to the liver

10. The fossae of the right portal vein (RPV) and gallbladder are found in the :
a. Main lobar fissure
b. Left intersegmental fissure
c. Right intersegmental fissure
d. Left lobar fissure

ANS: A
The main lobar fissure is a hyperechoic line extending from the RPV to the neck of the gallbladder. It is used as a landmark leading to the gallbladder fossa.

11. In severe hepatocellular destruction, the aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels are:
a. High
b. Moderately high
c. Moderate
d. Mild

ANS: A
In severe hepatocellular destruction, such as acute, viral, or toxic hepatitis, a striking elevation of AST and ALT may be observed. Levels frequently exceed 1000 units.

12. Elevation of alkaline phosphatase is associated with:
a. Biliary obstruction
b. Cavernous hemangioma
c. Fatty infiltration
d. Simple hepatic cysts

ANS: A
A significant elevation of alkaline phosphatase is typically associated with biliary
obstruction or the presence of mass lesions in the liver.[/size]

Page 1 of 11Copyright © 2012, 2006, 2001, 1995, 1989, 1983, 1978 by Mosby, an imprint of Elsevier Inc. Hagen: Textbook of Diagnostic Sonography, 7th Edition Chapter 10:

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[rtl]https://drive.google.com/file/d/0B2rdHo ... s3WkU/edit[/rtl]

13. Diminished vascular structures within the liver parenchyma most likely represent:

a. Obstructive portal disease

b. Cirrhosis

c. Budd-Chiari syndrome

d. Acute viral hepatitis

ANS: B

Sonographic findings in cirrhosis may include coarse liver texture (fibrosis and

nodularity). Increased attenuation may be present with a decrease in vascular

markings.

14. The falciform ligament extends from the umbilicus to the diaphragm in a

a. Ligamentum venosum

b. Ligamentum teres

c. Quadratus ligamentum

d. Ligamentum falciforme

ANS: B

The falciform ligament extends from the umbilicus to the diaphragm in a sagittal plane

and contains the ligamentum teres.

15. Elevation of serum bilirubin results in:

a. Hepatocellular disease

b. Ascites

c. Jaundice

d. Hemolysis

ANS: C

Elevation of serum bilirubin results in jaundice. Jaundice is a nonspecific finding seen

in massive blood breakdown, hepatocellular disease, or biliary obstruction.

16. ?Which one of the following actions should be done to image the near field of the liver?

a. Increase transducer frequency.

b. Change from a sector to a linear transducer.

c. Use a curved array transducer.

d. Increase the near gain.

ANS: C

Generally, a wider “pie” sector or curved linear array transducer is most appropriate to

image the near field of the abdomen optimally.

17. Typical symptoms a patient may have with an abscess formation include all of the following except:

a. Fever

b. Decreased white blood count

c. Pain

d. Increased white blood count

ANS: B

Clinical symptoms of an abscess include fever, abdominal pain, and an increase in

white blood count.

18. Jim MacDonald, a sheep farmer, arrives at the hospital with right upper quadrant pain, fever, and an elevated white blood cell count. He states that 3 months earlier,
he was kicked in the ribs. An irregular mass showing low-level echoes is found on
the sonogram.
What is your differential diagnosis?

a. Amebic abscess

b. Hematoma

c. Echinococcal cyst

d. Hepatic abscess

ANS: C

The best diagnosis is an echinococcal cyst. An abscess is a possibility, although with a

history of being a sheep herder, echinococcal cyst is more likely. A hematoma does

not cause a fever.

19. Which one of the following tumors consists of large blood-filled spaces?

a. Adenoma

b. Hamartoma

c. Ewing angioma

d. Cavernous hemangioma

ANS: D

A hemangioma is a benign tumor consisting of large blood-filled (cystic) spaces. Their

sonographic appearance may vary from small to large and hyperechoic to complex.

20. Dilated intrahepatic bile ducts may be seen with all of the following except:

a. Intrahepatic mass in the area of the porta hepatis

b. Gallstones in the fundus of the gallbladder

c. Obstructive stone in the cystic duct

d. Lymphadenopathy in the porta hepatis

ANS: B

Dilated intrahepatic ducts may be seen with gallstones in the neck of the gallbladder,

with an intrahepatic mass in the area of the porta hepatis; with an obstructive stone in

the cystic duct; and with lymphadenopathy in the porta hepatis.

21. Hepatocellular disease can be defined as a process that affects the:

a. Spherocytes and interferes with liver function

b. Phagocytes and does not interfere with liver function

c. Phagocytes and interferes with liver function

d. Hepatocytes and interferes with liver function

ANS: D

Hepatocellular disease can be defined as a process that affects the hepatocytes and

interferes with liver function.

22. In glycogen storage disease, type I is the most common and is also known as

a. von Gierke

b. von Gussel

c. von Gerpe

d. von Slurpie

ANS: A

The most common type of glycogen storage disease is type I, von Gierke disease in

which abnormal amounts of glycogen are deposited in the liver and kidneys.

23. All of the following describe normal portal venous flow except:

a. Low-flow velocity

b. Hepatofugal flow

c. Spontaneous flow

d. Phasic flow

ANS: B

The portal venous system demonstrates spontaneous, phasic, hepatopetal flow with a

low-flow velocity.

24. Which one of the following is noted in type I glycogen storage disease?

a. Small liver and hypoechoic parenchyma

b. Hyperechoic liver and hepatomegaly

c. Normal texture and hepatomegaly

d. Normal texture and prominent intrahepatic biliary ducts

ANS: B

Patients with type I glycogen storage disease demonstrate hepatomegaly, increased

echogenicity, and attenuation of the liver parenchyma.

25. All of the following statements are true about the features most often observed in
an extrahepatic mass except:

a. Internal invagination of the liver capsule

b. Formation of a triangular fat wedge

c. Discontinuity of the liver capsule

d. Anteromedial shift of the IVC

ANS: B

Extrahepatic mass or masses demonstrate discontinuity of the liver capsule, formation

of a triangular fat wedge, and anteromedial shift of the IVC or anterior displacement of

the right kidney.

26. All of the following statements are true about the features most often observed in
an intrahepatic mass except:

a. Anterior displacement of the right kidney

b. Displacement of the hepatic vascular radicles

c. External bulging of the liver capsule

d. Posterior shift of the IVC

ANS: A

Intrahepatic mass or masses demonstrate displacement of the hepatic vascular

radicles, external bulging of the liver capsule, or a posterior shift of the IVC.

27. The most common site for echinococcal virus growth is in the:

a. Lungs

b. Bones

c. Liver

d. Brain

ANS: C

After entering the proximal portion of the small intestines in humans, the larvae

burrow through the mucosa, entering the portal circulation and traveling to the liver.

28. The amebic abscess may reach the liver through the:

a. Hepatic artery

b. Gastroduodenal artery

c. Hepatorectal artery

d. Portal vein

ANS: D

The infection is primarily a disease of the colon; therefore the parasites reach the liver

via the portal vein.

29. What benign liver tumor is located near the free edge of the liver, solitary,

well-circumscribed, and a nonencapsulated multinodular mass?

a. Adenoma

b. Cavernous hemangioma

(c. Focal nodular hyperplasia (FHN

d. Lipoma

ANS: C

FHN generally demonstrates a solitary, well-circumscribed lesion located along the

subcapsular area of the liver. Lesions may be multiple and are typically found in

women under the age 40 years.

30. Common malignancies affecting the pediatric population include all of the

following except:

a. Neuroblastoma

b. Wilms tumor

c. Leukemia

d. Hepatoblastoma

ANS: D

Common malignancies affecting the pediatric population include the neuroblastoma,

Wilms tumor, and leukemia. Hepatoblastoma is a rare hepatic malignant tumor seen in

infancy and childhood.

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