The biliary system

1- What is indicated by the arrow in the above sonographic images?. Segment 5. Segment 1. Segment 8. Segment 4.

2- What is the indicated by the arrow in the above sonographic images?. Splenorenal Varices. Esophageal Varices. Cavernous Transformations. Recanalized Umbilical Vein.

3- Based on these LUQ sonographic images, what is the most likely primary disease?. Autosomal Dominant Polycystic Kidney Disease. Pulmonary Hypertension. Renovascular Hypertension. Cirrhosis.

4- A transjugular intrahepatic portosystemic shunt is typically placed between which two vessels?. Left Portal Vein and Middle Hepatic Vein. Right Portal Vein and Right Hepatic Vein. Middle Hepaic Vein and Main Portal Vein. Right Hepatic Vein and Main Portal Vein.

5- After placement of a transjugular intrahepatic portosystemic shunt, which of the following vessels has a change in flow direction?. Right Hepatic Vein. Recanalized Umbilical Vein. Main Portal Vein. Right Portal Vein.

6- The above sonographic images suggests: a TIPS occlusion. a properly functioning TIPS. the presence of a recanalized umbilical vein. a main portal vein occlusion.

7- Based on the sonographic images, all of the following are true except?. Deteriorating mental status changes is noted in the patient. The patient has recently become hypertensive. The patient has experienced rectal bleeding. (gastroesphoageal bleeding). The patient is experiencing abdominal distention.

8- Which of the following criteria suggests a properly functioning transjugular intrahepatic portosystemic shunt?. Hepatofugal right portal vein. TIPS (Portal end) velocity of 220 m/s. Hepatofugal main portal vein. Mid TIPS velocity of 40 m/s.

9- What is indicated by the arrow in the above sonographic images?. Common Bile Duct. Common Hepatic Artery. Common Hepatic Duct. Proper Hepatic Artery.

10- What is demonstrated in the above sonographic images?. Adenomyomatosis. Gas shadowing. Gallbladder polyps. Cholecystitis.

11- What hormone causes gallbaladder contraction and sphincter of Oddi relaxation?. Insulin. Amylase. Choecystokinin. Lipase.

12- What is the arrow indicating in the above sonographic images at the porta hepatis?. Common Bile Duct. Common Hepatic Artery. Common Hepatic Duct. Proper Hepatic Artery.

13- This patient presents to the emergency department with RUQ pain, anorexia, nausea, vomiting, fever, leukocytosis and chills. What is the arrow indicating in the above sonographic images?. Uncompilicated cholecystitis. Pericholecystic abscess. Uncomplicated ascites. Perichoecystic hematoma.

14- What is indicated by the arrow in the above sonographic image?. Common Hepatic Duct. Proper Hepatic Artery. Right Hepatic Artery. Left Hepatic Artery.

15- What is the most likely diagnosis pertaining to the above sonographic images?. Ampulla of Vater Stone. Mirizzi Syndrome. Pancreatic Cancer. Choledocal Cyst.

16- Based on the above sonographic images, all of the following serum chemistries would most likely be elevated except: Alpha Fetoprotein. Gamma glutamyl Transpeptidase. Congugated Bilirubin. Alkaline Phosphatase.

17- Based on the above sonographic images, which of the following serum chemistries would be profoundly elevated?. Direct bilirubin. Alpha fetoprotein. Indirect bilirubin. Lactic Dehydrengenase.

18- What is indicated by the arrow in the above sonographic images?. Gastroduodenal artery. Cystic Duct. Duct of Wirsung. Splenic vein.

19- Based on the above sonographic images, all of the following serum chemistries are elevated except: Lactic Dehydrogenase. Gamma Glutamyl Transpeptidase. Alkaline Phosphatase. Conjugated Bilirubin.

20- What is indicated by the arrow in the above sonographic image?. Duct of Wirsung. Common Bile Duct. Gastroduodenal Artery. Duct of Santorini.

22- What are the three vessels of the portal triad at the porta hepatis as demonstrated in the above sonographic images?. Common Bile Duct, Common Hepatic Artery, Main Portal Vein. Proper Hepatic Artery, Common Bile Duct, Main Portal Vein. Main Portal Vein, Common Hepatic Artery, Common Hepatic Duct. Main Portal Vein, Proper Hepatic Artery, Common Hepatic Duct.

22- The patient has a history of biliary stricture post-operative cholecystectomy. What is indicated by the arrows in the above sonographic images?. Common hepatic artery stent. Transjugular intrahepatic portosystemic shunt. Diabetic with calcified proper hepatic artery. Bile duct stent.

23- What is indicated by the arrow in the above sonographic images?. Main Portal Vein. Superior Mesenteric Vein. Inferior Vena Cava. Aorta.

24- What is indicated by the arrow in the above sonographic images?. Common Bile Duct. Cystic Duct. Common Hepatic Duct. Left Hepatic Duct.

25- What is indicated by the arrow in the above images?. Common Hepatic Duct. Santorini's Duct. Common Bile Duct. Cystic Duct.

26- What is indicated by the red arrows in the above images?. Wirsung's Duct. Common Bile Duct. Common Hepatic Duct. Cystic Duct.

27- What is indicated by the arrows in the above sonographic images?. Common Hepatic Artery. Right Gastroepiploic Artery. Gastroduodenal Artery. Common Bile Duct.

28- What condition is indicated by the above images?. Caroli disease. Sclerosing cholangitis. Polycystic Liver Disease. Choledochal Cyst (Type I).

29- What post-cholecystectomy common bile duct size suggest a distal obstruction?. Greater than 8 mm. Greater than 13 mm. Greater than 10 mm. Greater than 6 mm.

30- What is indicated by the red arrows in the above images?. Cystic Duct. Duct of Wirsung. Common Bile Duct. Common Heptic Duct.

31- What is the term for a cholangiocarcinoma located in the porta hepatis at the junction of the right and left hepatic ducts?. Grawitz Tumor. Klatskin tumor. Ackerman Tumor. APUD Tumor.

32- What condition is indicated in the above sonographic images?. Cholangiocarcinoma. Cholecystitis. Choledochal Cyst. Cholangitis.

33- What is indicated by the arrow in the above sonographic images?. Gastroduodenal Artery. Common Hepatic Artery. Common Hepatic Duct. Common Bile Duct.

34- Based on the above sonographic images, what is the appropriate diagnosis?. Choledochlithiasis. Courvoisiers Gallbladder. Adenomyomatosis. Cholecystitis.

36- What is the most common precipitating cause of cholecystitis?. Cystic duct stone. Common bile duct stone. Choleangitis. A bacterial infection.

36- All of the following are associated with acalculous cholecystitis except: Mirizzi Syndrome. HIV / AIDS. Severe burns. Post-operative abdominal surgery.

37- All of the following are associated with gallbladder wall thickening except: Portal hypertension. Congestive heart failure. Ascites. Hypoalbuminemia.

38- What condition is indicated by the above images?. Choledochal Cyst (Type II). Caroli Disease (Type V). Sclerosing cholangitis. Choledochal Cyst (Type I).

39- What gallbladder wall dimension suggest cholecystitis?. Greater than 3 mm. Greater than 2 mm. Greater than 5 mm. Greater than 6 mm.

40- What is indicated by the arrow in the above sonographic images?. Aorta. Inferior Vena Cava. Ascites. Gallbladder.

41- What is the name for a diverticula of the gallbladder at the junction of the neck of the gallbladder and the cystic duct?. Junctional Pouch. Hartmann's Pouch. Phrygian Cap. Choledochal Cyst.

42- What sign is associated with cholecystitis?. Rovsing's Sign. Dunphy's Sign. McBurney's Sign. Murphy's Sign.

43- What is the condition demonstrated in the above illustration and sonographic image?. Sclerosing cholangitis. Choledochal Cyst (Type III). Caroli's Disease. Choledochal Cyst (Type I).

With cholecystitis, which laboratory value would definitely be elevated. Laboratory values may be normal with cholecystitis. Alkaline phosphatase. Bilirubin. Alanine aminotransferase.

45- Which serum chemistry dominates the laboratory profile with primary sclerosing cholangitits?. Unconjugated Bilirubin. Alanine aminotransferase. Conjugated Bilirubin. Alkaline Phospatase.

46- All of the following would be elevated with an ampulla of Vater stone except: Gamma Glutamyl Transpeptidase. Hematocrit. Amylase. Alkaline Phosphatase.

47- Choledocholithiasis is associated with all the following except: Pancreatitis. Portal Hypertension. Cholangitis. Jaundice.

48- What is represented in the above sonographic images?. Caroli's Disease. Choledocholithiasis. Mirizzi Syndrome. Cholangiocarcinoma.

49- Which of the following chemistry profiles would most likely be elevated with choledocholithiasis?. Conjugated bilirubin, alanine aminotransferase , and gamma glutamyl peptedase. Lactic dehydrogenase, alkaline phosphatase, and gamma glutamyl transferase. Conjugated bilirubin, alkaline phosphatase, and gamma glutamyl transferase. Gamma glutamyl peptedase, direct bilirubin, lactic dehydrogenase.

50- With stones that appear to be fixed in the gallbladder neck, an attempt should be made to dislodge the stone. All of the following patient positions will facilitate disloging the stone except: Left lateral decubitus. Standing. Sitting. Right lateral decubitus.

51- What disease is seen more commonly in the Asian population and is diagnosed by the presence of two right upper quadrant cystic structures and intrahepatic ductal dilatation?. Choledochal Cyst. Sclerosing cholangitis. Mirizzi Syndrome. Caroli's Disease.

52- What condition is characterized by abnormal deposition of cholesterol and triglycerides within the wall of the gallbladder?. Cholecystitis. Adenomyomatosis. Gallbadder Hydrops. Cholesterolosis.

53- Air within the gallbladder seen as echogenic foci with an associated comet-tail artifact may suggest what diagnosis?. Emphysematous Cholecystitis. Mirizzi Syndrome. Adenomyomatosis. Choledochal Cyst.

54- What is the most likely diagnosis in a febrile patient with gallbladder wall thickening and hyperechoic bile as demonstrated in the above sonographic images?. Emphysematous Cholecystitis. Empyema. Sludge. Gallbadder Hydrops.

55- In Western cultures, what is the largest component of gallstones?. Calcium bilirubinate. Calcium carbonate. Bile pigment. Cholesterol.

56- What is indicated by the arrows in the above sonographic images?. Pyogenic Abscess. Gallbladder. Hepatic Cyst. Ecchinococcal Cyst.

57- Decreasing bile duct diameter post fatty meal suggests: absence of a biliary obstruction. cholangiocarcinoma. a pancreatic head mass. an ampulla of Vater stone.

58- A patient presents with a palpable RUQ mass. Based on the above sonographic images, what is the most likely diagnosis?. Adenomyomatosis. Sludge. Hydropic Gallbladder. Gallbladder Cancer.

59- What is the term used by pathologists that refers to numerous flecks of yellow cholesterol deposits against the red mucosa of the gallbladder as seen in the above sonographic images and on gross examination?. Sting of Pearls. Strawberry Gallbladder. Pomegranate Gallbladder. Necklace Sign.

60- Emphysematous Cholecystitis is associated with all of the following except: Air within the gallbladder wall. Air within the gallbladder lumen. Air within the gallbladder lumen. Air within the portal vein.

61- The gallbladder commonly folds upon it self. What is it called when the gallbladder folds between the body and fundus?. Submucosal folds. Haustral fold. Phrygian cap. Junctional fold.

62- What is the term for a grossly distended, thin-walled gallbladder measuring greater than 5 cm in the transverse diameter with a gallbladder neck stone?. Choledochal Cyst. Empyema. Phrygian cap. Gallbladder Hydrops.

63- What is being demonstrated in the above sonographic images?. Gallbladder Cancer. Cholesterolosis. Gallbladder Polyps. Adenomyomatosis.

64- Which statement is true based on the above sonographic images?. The sonographic images suggest chronic cholecystitis. The sonographic images suggest acute cholecystitis. Cholecystitis can not be diagnosed based on the sonographic images. A hydropic gallbladder is suggested by the sonographic images.

65- What condition is caused by reduced blood supply to the gallbladder resulting in tissue death?. Chronic Cholecystitis. Acute Cholecystitits. Cholesterolosis. Gangrenous Cholecystitis.

66- The above sonographic images demonstrate gallbladder perforation with pericholecystic fluid. Which of the following has a higher incidence of gallbldder perforation?. Cholesterolosis. Gangrenous Cholecystitis. Chronic Cholecystitis. Empyema.

67- What is demonstrated in the above sonographic images. Hepatic Artery Collateralization. Biliary Necrosis. Hepatic Artery Dissection. Intraheptaic Duct Dilatation.

68- What is indicated by the red arrow in the above sonographic images?. Left Hepatic Vein. Left Portal Vein. Left Hepatic Artery. Recanalized Umbilical Vein.

69- What is indicated by the red arrow in the above sonographic images?. Right Hepatic Artery. Right Portal Vein. Right Hepatic Vein. Left Portal Vein.

70- What irregular and tortuous hepatic vessels are demonstrated in the above sonographic images?. Hepatic Veins. Portal Veins. Hepatic Arteries. Dilated Intrahepatic Ducts.

71- What is it called when the gallbladder folds between the neck and body?. Submucosal Fold. Haustral Fold. Junctional Fold. Phrygian Fold.

72- All of the following are causes of diffuse gallbladder wall thickening except: Ascites. Hypoalbuminemia. Hepatitis. Pyelonephritis.

73- Where is the most common location for obstruction of the biliary tract by a stone?. Junction of the right and left hepatic duct. Common hepatic duct. Distal common bile duct. Duct of Wirsung.

74- What term describes a chronic cholecystitis in which excessive amounts of calcium carbonate saturated bile results in sonographic shadowing and opacification of the gallbladder on plain abdominal radiographs?. Porcelain Gallbladder. Adenomyomatosis. Cholesterolosis. Milk of Calcium Bile.

75- What is indicated by the arrow in the above sonographic image?. Sandwich Sign. WES Sign. Parallel Channel Sign. Mantle Sign.

76- What is extrahepatic biliary obstruction caused by a stone in the cystic duct that extrinsically compresses the common hepatic duct?. Gallbladder Hydrops. Mirizzi Syndrome. Courvoisier Gallbladder. Choledochal Cyst (Type I).

77- What is demostrated in the above sonographic images?. Calcified Hepatic Arteries. Extrapulmonary pneumocystosis. Pneumobilia. Hepatic Granulomas.

78- Noninvasive causes of pneumobilia are uncommon and are usually indicative of serious disease. All of the following are causes of noninvasive pneumobilia except: Emphysematous cholecystitis. Biliary-enteric fistula. Extrapulmonary pneumocystosis. Incompetence of the sphincter of Oddi.

79- What is indicated by the arrow in the above sonographic image?. Grating lobe artifact. Edge artifact. Comet-tail artifact. Sartifactide lobe.

80- What is indicated by the arrows in the above sonographic images?. Emphysematous cholecystitis. WES sign. Porcelain Gallbladder. Adenomyomatosis.

81- What is indicated by the arrows in the above soographic images?. Common Bile Duct. Cystic Duct Stone. Valves of Heister. Anomalous Cystic Duct.

82- The above sonographic image is in the transverse plane at the porta hepatis. What is indicated by the yellow arrow?. Common Hepatic Duct. Common Bile Duct. Common Hepatic Artery. Proper Hepatic Artery.

83- What level of obstruction is associated with a distended gallbladder?. Duct of Santorini. Common Bile Duct. Hepatic Duct Junction at Porta Hepatis. Common Hepatic Duct.

84- All of the following are associated with a distended gallbladder except: Common bile duct stone. Mirizzi syndrome. Klatskin tumor. Adenocarcinoma of the pancreatic head.

85- What is indicated by the arrow in the above sonographic image?. Left Portal Vein. Inferior Vena Cava. Main Portal Vein. Right Portal Vein.

86- What is demonstrated in the above sonographic images?. Sludge. Gallbladder Carcinoma. Milk of Calcium Bile. Hematobilia.

87- The above sonographic image is in the transverse plane at the porta hepatis. What is indicated by the yellow arrow?. Common Hepatic Artery. Proper Hepatic Artery. Common Bile Duct. Common Hepatic Duct.

88- When sludge becomes thickened and viscous it may aggregate and become mass-like, mimicing a soft tissue mass. What is this condition called?. Hemobilia. Milk of Calcium Bile. Tumefactive Sludge. Porcelain Gallbladder.

89- What is demonstrated in the above sonographic images?. Milk of Calcium Bile. Porcelain Gallbladder. Parallel Channel Sign. WES Sign.

90- Porcelain Gallbladder is consider to be a precursor to what condition?. Klatskin Tumor. Gallbladder Cancer. Acute Cholecystitis. Cholangiocarcinoma.

What is indicated by the arrow in the above sonographic image?. Gastroduodenal Artery. Right Hepatic Artery. Proper Hepatic Artery. Common Hepatic Artery.

92- Abdominal ultrasound performed post motor vehicle accident with RUQ trauma. Based on the above sonographic images, what would be the most likely diagnosis?. Hemobilia. Milk of calcium bile. Sludge. Empyema.

93- What is the cause of gallbladder sludge?. Gallbladder Stasis. Hemolysis. Pancreatic dysfunction. Gallbladder ischemia.

94- What is demonstrated in the above images?. Porcelain Gallbladder. Emphysematous Cholecystitis. Empyema. Adenomyomatosis.

What is indicated by the arrow in the sonographic image?. Main Portal Vein. Right Portal Vein. Superior Mesenteric Vein. Splenic Vein.

96- What is indicated by the arrow in the above sonographic images?. Gastroduodenal Artery. Common Hepatic Artery. Right Hepatic Artery. Proper Hepatic Artery.

97- What is indicated by the arrow in the sonographic images?. Hepatic Duct. Hepatic Vein. Hepatic Artery. Portal Vein.

98- What is the name of the intramural diverticula associated with adenomyomatosis?. Robitussin-Ashcrot sinus. Rubinstein-Arthur sinus. Rubikon-Ashton sinus. Rokitansky-Aschoff sinus.

99- What is demonstrated in the above sonographic images?. Transjugular Intrahepatic Portosystemic Shunt. Recanalized Umbilical Vein. Inferior Vena Cava. Portal Vein Stent.

100- What is demonstrated in the above composite sonographic image?. Metastatic Liver. Lymphomatous Liver. Riedel's lobe. Hepatomegaly.