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Liver
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Questions in this quiz (98)
1The liver is covered directly by which of the following?
- AGerota's fascia
- BGlisson's capsule
- CMorrisons fascia
- DParietal peritoneum
2Which of the following is not a bare area of the liver?
- AMorrison's pouch
- BSuperior surface to the right of the IVC
- CPortion of the porta hepatis
- DGallbladder fossa
3Which of the following indicates hepatomegaly in a pediatric patient?
- ALiver extends more than 1cm subcostal
- BLiver extends inferior to the lower pole of the RK
- CLiver extends towards the spleen
- DLiver measures > 16cm CC
4Which of the following structures is not posterior to the right lobe of the liver?
- Ahepatic flexure of the colon
- Bright kidney and adrenal gland
- Cdescending portion of the duodenum
- Ddiaphragm
- Egallbladder
5The right hepatic vein divides the liver into what two portions?
- Aright and left
- Bright anterior and right posterior lobe
- Cright superior and right inferior lobes
- Dleft medial and left lateral lobes
6The lateral left lobe of the liver is anterior to all of the following except:
- AStomach
- BEG junction
- CAorta
- DCeliac axis
- ESMA
- FPancreatic body and tail
- GCaudate lobe
- HSpleen
7Medial left lobe of the liver was formerly called what?
- AQuadrate lobe
- BReidels lobe
- CSupracaudate lobe
- DBiliary lobe
8Where is the triangular ligament of the liver located?
- Amedial and lateral edges of bare area
- Bbetween the medial and lateral left lobes of of the liver
- Csuspending the posterior surface of the liver from the diaphragm
- Dattaching the superior surface from diaphragm to umbilicus
9Which of the following ligaments is the coronary ligament attached to?
- Atriangular ligaments and falciform ligament
- Bligamentum teres and ligamentum venosum
- Cfalciform ligament and broad ligament
- Dhepatoduodenal ligament and falciform ligament
10Which of the following is found in the inferior margin of the falciform ligament?
- ALeft portal vein
- BRight portal vein
- CLigamentum teres
- DLigament venosum
11Which of the following structures separates the medial and lateral left lobes of the liver?
- ALeft portal vein
- BLeft hepatic vein
- CLigamentum teres
- DLigamentum venosum
12Ligamentum venosum is best described by which of the following?
- ARemnant of fetal circulation. Allowed majority of oxygenated maternal blood to bypass the fetal liver and enter IVC for distribution.
- BPeritoneal folds at the porta hepatis surrounding the portal vein, bile duct, and hepatic artery
- CAttached to the superior surface of the abdominal wall from diaphragm to umbilicus. Courses within the let intersegmental fissure from the umbilicus to the left portal vein.
- DThe ligament which the left portal vein courses through. Separates the liver into medial and lateral left lobes.
13Which of the following structures is a peritoneal fold at the porta hepatis surrounding the portal vein, bile duct, and hepatic artery?
- AHepatoduodenal ligament
- BLigamentum venosum
- CMain hepatic ligament
- DMain lobar fissure
14What structure appears to be connecting the neck of the gallbladder to the right portal vein?
- AMain lobar fissure
- BRight intersegmental fissure
- CCommon bile duct
- DCommon hepatic duct
15The right intersegmental fissure divides the right anterior and right posterior portions of the liver along which plane?
- ATransverse
- BLongitudinal
- CCoronal
16Which plane does the left intersegmental fissure divide the left medial and left lateral portions of the liver along?
- ALongitudinal
- BTransverse
- CCoronal
17How many segments of the liver are there in the couinaud liver segmentation?
- A8
- B7
- C9
- D12
18The CHA contains ___% oxygenated blood, supplies ___% of blood volume, and ___% of total oxygen to the liver
- A95, 20, 50
- B95, 50, 20
- C30, 95, 40
- D40, 30, 95
19What is the most common variation of hepatic artery branching?
- Aright hepatic artery from SMA and left hepatic artery from LGA
- Bright hepatic artery from left gastric artery, left hepatic artery from SMA
- CGDA from splenic artery and CHA from SMA
- Dright hepatic artery from AO and left hepatic artery from SMA
20What is the normal post prandial hepatic artery evaluation?
- Aincreased RI
- Bdecreased RI
- Cno change in RI
21An RI >____ in the hepatic artery can indicate hepatic congestion, transplant rejection, or chronic hepatocellular disease.
- A0.8
- B0.5
- C0.6
- D0.7
22The confluence of the SMV and SV occurs posterior to the _____ and is called the _____ confluence.
- Apancreatic head, portal venous
- Bpancreatic body, portal venous
- Cpancreatic neck, portal venous
- Dpancreatic tail, portal venous
23The portal vein carries ___% of the blood volume, ___% of the oxygen for the liver, and ___% oxygenated blood.
- A80%, 50%, 85%
- B20%, 50%, 95%
- C20%, 30%, 95%
- D30%, 20%, 95%
24Portal veins are _________ structures, while hepatic veins are __________ structures.
- Aintrasegmental, intersegmental
- Bintersegmental, intrasegmental
25Which of the following indicates portal HTN?
- APressure > 5-10 mmHg, no change in diameter post prandial, and no change in diameter upon inspiration
- BPressure >2-7 mmHg, large change in diameter post prandial, large change in diameter upon inspiration.
- CIncrease in flow volume post prandial and upon inspiration
- DDecrease in flow volume when sitting up or after exercising
26Which of the following describes the correct way to measure the main portal vein?
- Ameasure with patient supine in quiet respiration at the point the MPV crosses the IVC. Inner wall to inner wall
- Bmeasure with patient supine in quiet respiration at the point the MPV crosses the IVC. outer wall to outer wall
- Cmeasure with the patient erect, full inspiration at the point the MPV crosses the IVC including the wall
- DMeasure with the patient in quiet respiration, LLD, at the point the MPV crosses the IVC. Outer wall to outer wall.
27the flow of the MPV should be ____
- Aantegrade
- Bretrograde
- Chepatopetal
- Dhepatofugal
28Which of the following best describes the position of the IMV in relation to the IMA?
- Ato the right
- Bto the left
- Csuperior
- Dinferior
29Which of the following are the largest IVC tributaries in the abdomen?
- AIliac veins
- BPortal veins
- CHepatic veins
- DRenal veins
30What does the normal doppler tracing of the hepatic veins demonstrate?
- ATwo large antegrade diastolic and systolic waves followed by a small retrograde component corresponding with atrial contraction.
- BTwo large retrograde diastolic and systolic waves followed by a small antegrade component corresponding with atrial contraction.
- COne large retrograde diastolic wave followed by a small antegrade component that corresponds with atrial contraction.
- DOne large antegrade diastolic wave followed by a small retrograde component that corresponds with atrial contraction.
31What are the functional units of the liver?
- ALobules
- Bportal triads
- Chepatocytes
- Dlobes
32True or false: hepatocytes surround the periphery of veins, synthesize, metabolize, and excrete compounds
- ATrue
- BFalse
33Which of the following is not a function of the liver?
- Ametabolism of carbohydrates
- Bdetoxification of alcohol and wastes
- Cbile production and excretion
- Dformation of albumin and globulin
- ELymph production
- FRed blood cell production
34True or false: AST is elevated with isolated biliary obstruction
- ATrue
- BFalse
35Which of the following is used to assess the level of jaundice and monitor hepatitis and cirrhosis?
- AAST
- BALT
- CALP
- DGGTP
36Which of the following is indicative of biliary obstruction?
- AElevated GGTP and ALP
- BElevated GGTP and AST
- CElevated AST and ALT
- DElevated GGTP and ALT
37Which of the following indicates hepatocellular disease?
- AElevated GGTP and ALP
- BElevated GGTP and ALT
- CElevated ALT and ALP
- DElevated GGTP and AST
38Which of the following labs is the most sensitive indicator for alcoholism?
- AGGTP
- BAST
- CALT
- DALP
39LDH is non specific and needs other lab work done to determine source of elevation, true or false?
- Atrue
- Bfalse
40When PT is increased, the administration of vitamin K can be used to determine origin of increase. When the PT decreases after vitamin K, this indicates _____ was the cause, but if it does not improve after vitamin K, it indicates _____ is the cause.
- Abiliary stasis, hepatocellular disease
- Bhepatocellular disease, biliary stasis
- Cretroperitoneal bleed, hepatocellular disease
- Dlymphedema, retroperitoneal bleed
41Which of the following is CA 125 used to detect?
- AOvarian cancer
- BEndometriosis
- CLung cancer
- DGI cancer
- EPancreatic cancer
- FColorectal cancer
- GBile duct cancer
- HTesticular cancer
42Which of the following is CA 72-4 used to screen for?
- AOvarian cancer
- BEndometriosis
- CLung cancer
- DGI cancer
- EPancreatic cancer
- FColorectal cancer
- GBile duct cancer
- HTesticular cancer
43Which of the following is CA 19-9 used to screen for?
- AOvarian cancer
- Bendometriosis
- Ctesticular cancer
- Dpancreatic cancer
- Ecolorectal cancer
- Fbile duct cancer
44Which of the following describes the relative echogenicities in the abdomen from hyperechoic to hypoechoic?
- Arenal sinus> pancreas> liver> spleen> renal parenchyma
- Brenal sinus> liver> pancreas>spleen> renal parenchyma
- Crenal sinus> pancreas> spleen> liver> renal parenchyma
- Drenal sinus> liver> spleen> pancreas> renal parenchyma
45An otherwise healthy 20 year old female presents for an ultrasound due to epigastric pain. Upon evaluation of the liver, you notice that the right lobe extends past the inferior portion of the right kidney. This part of the liver is not rounded and all LFTs are WNL. What is this?
- AReidel lobe
- BHepatomegaly
- CDistal papillary process
- DExtended left lobe
46A patient has multiple communicating cysts throughout the liver. This is causing biliary stasis and impairing the function of the liver. The patient is jaundiced and has elevated bilirubin. What are these findings?
- ACaroli disease
- Bsimple cysts
- Cpolycystic liver disease
- Dhemorrhagic cysts
47When multiple cysts are found in the liver, not communicating with the biliary tree, what other structures should be evaluated?
- AKidneys, pancreas, ovaries
- BSpleen, kidneys, ovaries
- CTesticle, kidney, spleen
- DThyroid, pancreas, ovaries
48What is a meyenburg complex?
- Adilated intrahepatic ducts with dense stroma
- Babnormal arrangement of hepatocytes and biliary structures
- Cproliferation of vascularity in a section of the liver
- DMalignant collections of biliary cells in the liver
49True or false: the hepatic veins can have increased phasicitiy in advanced fatty liver.
- ATrue
- BFalse
50What is the most common form of glycogen storage disease?
- AType I
- BType II
- CType III
- DType IV
51A patient presents with Kayer-Flescher rings. What do you expect to find in their liver?
- AIncreased copper
- BIncreased iron
- CIncreased fat
- DIncreased glycogen
52Select all of the following that apply to sonographic appearance of Wilson's disease:
- AEchogenic fatty liver
- BFibrotic periportal thickening
- CNodular cirrhotic changes
53True or false: cirrhosis is a irreversible, diffuse liver disease
- Atrue
- Bfalse
54____ is the most common cause of cirrhosis. ______ is the second most common cause.
- AHepatitis, alcohol abuse
- BChronic liver disease, biliary obstruction
- CBiliary obstruction, alcohol abuse
- DGlycogen storage disease, alcohol abuse
55A patient presents with increased abdominal girth, elevated LFTs, weight loss, and jaundice caused by cirrhosis. How do you expect their liver to appear on ultrasound?
- Adecreased liver size
- Bcoarse echotexture
- CNodular formation
- Dcaudate lobe/right lobe ration > 0.65
- Esplenomegaly
- FNo change in portal vein diameter with respiration
- Gdiminished change in RI post prandial
- Hvaricies with cavernous formation
- Iall of these
56A patient with a history of IV drug abuse presents to the ultrasound department with nausea, jaundice, malaise, and dark urine. His labs demonstrate elevated AST, ALT, ALP, and direct bilirubin. He has prolonged PT and elevated LDH. How do you expect his liver to appear in the acute stages of this disease?
- AHypoechoic and enlarged with starry sky appearance
- BHyperechoic and small due to fibrotic changes
- CHyperechoic and enlarged due to fat infiltration
- DHypoechoic and small due to ascitic changes
57A patient with a history of recurrent liver infection presents to the ultrasound department for a follow up ultrasound. The ultrasound shows a small liver with granuloma formation presenting as punctate calcifications with or without shadowing. Elastography values have increased since his last ultrasound 1 year ago. What does this patient have?
- AAcute hepatitis
- BChronic hepatitis
- CCirrhosis
- DBudd Chiari
58A patient with known acute hepatitis presents to the emergency room with a sudden onset of epigastric pain 3 hours after his last meal. What is the most likely diagnosis for this patient?
- ACholecystitis
- BCorsoviers GB
- CPorcelain GB
- DRuptured hepatic adenoma
59A patient recently went on a trip to a foreign country. She presents with a low grade fever, nausea, and a positive Casoni skin test at her primary care office. Her WBC are elevated. What should you expect to see on ultrasound?
- ALarge cysts with daughter cysts within
- BHoneycomb or waterlily sign
- CThick or calcified walls
- Dcalcified mass
- Eall of the above
60True or false: another name for echinococcal cyst is hydatid disease
- Atrue
- Bfalse
61Which of the following is the most common parasitic infection in humans?
- ASchistosomaiasis
- BHydatid
- CPneumocystis Jirovecci
- DPneumocystis Carinii
62An otherwise healthy patient with no relevant medical history presents with an onset of portal hypertension caused by schistosomiasis. What are you expecting to see?
- AThick echogenic portal vein walls with debris/occlusion in the portal venous system. Decreased size of the liver. Cystitis with diffuse bladder calcifications
- BEnlarged hypoechoic liver with increased portal echos causing the starry sky sign. Thick gallbladder wall with positive sonographic murphys sign. Diffuse calcifications throughout the pancreas
- CNormal sized liver with granuloma formation presenting as hyperechoic to calcified nodules less than 1 cm that may or may not shadow. Splenomegaly
- DSmall hyperechoic with nodular surface contour. Free fluid throughout the abdomen with enlarged caudate lobe, causing CL/RL ratio to be >0.65
63Which of the following is a yeast like fungus that can cause life threatening pneumonia in patients with AIDS? it presents as diffuse echogenic foci formation without the presence of shadowing.
- APneumocystis Jirovecci
- BSchistosomiasis
- CHydatid disease
- DEchinococcal infection
64How can ultrasound differentiate between a pyogenic abscess and a fungal (candidiasis) abscess?
- ACandidiasis presents as multiple small abscesses throughout the liver while pyogenic abscesses are usually single
- BPyogenic abscesses present as multiple small abscesses throughout the liver while candidiasis are usually single
- CCandidiasis does not cause a fever while pyogenic abscess does
- DPyogenic abscess does not cause a fever while candidiasis does
65A pregnant patient presents to the ultrasound for follow up of a benign, hyperechoic, small, homogeneous mass in the right lobe of her liver. The doctor wants to check that the size is stable during her pregnancy because the mass has a tendency to grow with increased estrogen. This mass is composed of mostly blood vessels. On a prior contrast enhanced ultrasound, the mass was found to enhance throughout the arterial and portal venous phases. What kind of mass does she have?
- AFNH
- Bhemangioma
- Cadenoma
- Dlipoma
66A 6 month old is sent for an ultrasound due to a palpable mass in the RUQ and jaundice. The patient has significant thrombocytopenia and visible blue cutaneous lesions on their extremities. What is the expected finding?
- AKabasch-Meritt syndrome
- BFNH
- CAdenoma
- DInfantile hemangioendothelioma
67What is the most common benign vascular liver tumor in infancy?
- AInfantile hemangioendothelioma
- BInfantile FNH
- CInfantile Adenoma
- DInfantile Hemangioma
68A mass is seen on ultrasound and the radiologist recommends a sulfur colloid Nuclear medicine exam. What mass does the radiologist suspect?
- AFNH
- BAdenoma
- CHemangioma
- DCarcinoima
69Which of the following does not describe the typical appearance of a FNH?
- ASolitary mass >5cm that is difficult to separate from the surrounding tissue
- BContrast filling at the center then moving peripherally (centrifugal enhancement)
- CProminent spoke wheel vascularity with central scar. Displaces vascular structures and disrupts capsule contour.
- DContrast filling peripherally then moving towards the center (centripetal ehnacement)
70A patient presents with a single, well defined mass that is hypoechoic. The radiologist cannot use ultrasound to differentiate between FNH and Adenoma. He elects to do a biopsy and finds atypical hepatocyte formation in a well encapsulated mass. He recommends surgical removal due to malignant potential and risk of hemorrhage. What mass is it?
- AFNH
- BAdenoma
71Patients with cirrhosis are at an increased risk for which of the following?
- AAdenoma formation
- BHepatocellular Carcinoma formation
- CFNH formation
- DMetastatic disease
72Which of the following is not a symptom of HCC?
- Aweight gain due to ascites
- Bfever
- Chepatomegaly
- Dpalpable mass
- Eweight loss
- Fascites
73What liver structure does HCC most commonly invade?
- AGallbladder and ducts
- Bhepatic artery
- Chepatic vein
- DPortal vein
74Which of the following does not describe the sonographic appearance of HCC?
- AFibrosis and necrosis causing heterogeneity increasing with age
- BLarge focal mass or multifocal diffuse infiltration
- CHypervascularity with high velocity low resistive waveform. Constant flow throughout the cardiac cycle. Washout during the venous phase
- DHalo of hypoechoic tissue surrounding echogenic tissue.
- ELarge, hypervascular, hyperechoic mass that does not washout during the portal venous phase
75Which of the following is a solitary mass presenting with normal levels of AFP that can grow 6-22cm. It is a subtype of HCC found in adolescents and young adults without coexisting liver disease. Punctate calcifications are seen with an echogenic scar that differentiates it from hepatoma.
- AHepatoblastoma
- Bhemangioendothelioma
- CFibrolamellar carcinoma
- DMetastatic disease
76This mass is associated with Beckwith Wiedemann syndrome and familial adenomatous polyposis. It is often palpable and found in children before the age of two. It is the #1 primary liver malignancy in children. AFP is usually increased. What is this mass?
- AFibrolamellar carcinoma
- Bhemangioendothelioma
- CHepatoblastoma
- DAdenoma
77Which of the following statements regarding liver mets is incorrect
- Aliver mets is 20x more likely than primary cancer, making it the most common solid mass of the liver
- B50% of mets are carried to the liver by the portal venous system
- CHalo sign should be suspicious for malignancy. When halo is found in patient with history of some other primary cancer, usually mets. When patient has coexisting liver disease and no other cancer, usually HCC
- DHyperechoic lesions are related to GI or primary HCC
Hyperechoic lesions with hypervascularity are related to RCC
Hypoechoic lesions are usually lymphoma, breast, or lung
Bullseye is uncommon but could be lung or colon
Cystic lesion is usually sarcoma
Calcified are usually mucinous adenocarcinoma of the colon - EAll of the above statements are true
78What is the most common liver malignancy associated with HIV/ AIDS?
- AKaposi Sarcoma
- BLymphoma
- CPneumocystis Carinii
- DMetastatic disease
79What is the most common finding in hepatic congestion?
- ADilated IVC
- BAbsence of flow in the portal vein
- Ctumor formation in the liver
- Dinfarction at the porta hepatis
80______ is the most common reason for liver transplant in adults and _____ is the most common reason in children.
- AHepatitis C, biliary atresia
- BBiliary atresia, hepatitis C
- CCirrhosis, Biliary atresia
- DHepatitis A, Biliary atresia
81What is the most common cause of intrahepatic cholestasis?
- AHepatitis
- BCirrhosis
- CObstruction at the ampulla of vater
- DCholecystitis
82What are the two most common causes of granuloma formation?
- Ahistoplasmosis and tuberculosis
- Bschistosomiasis and tuberculosis
- Chistoplasmosis and schistosomiasis
- Dpneumocystis carinii and tuberculosis
83Which lobe of the liver is not expected to change size at all with budd chiaria?
- Aright
- Bleft
- Ccaudate
- Dquadrate
84A patient with known renal cancer is now presenting with jaundice, hematemesis, ascites, hepatomegaly, and portal HTN. These symptoms just started and the ultrasound shows hepatomegaly with thick walled hepatic veins that are very difficult to visualize due to atrophy. There is splenomegaly and the portal vein has reversed flow. The flow through the hepatic veins is very turbulent and continuous. What is the diagnosis for this patient?
- ACirrhosis
- BBudd-Chiari Syndrome
- CAdvanced portal hypertension
- DHepatic infarct
85True or false: the liver is enlarged in the chronic stage of Budd-Chiari Syndrome, but decreased in the acute stage
- AFalse
- BTrue
86True or false: free air in the hepatic venous system can cause pulmonary embolism and is caused by bacterial infection. Presents as mobile echogenic foci with ringdown artifact.
- ATrue
- BFalse
87A patient with CHF presents with a palpable liver and increased LFT. What do you expect to see on ultrasound?
- AHepatomegaly
- Bdilated IVC (>2.5cm) loss of respiratory phasicity
- CDilated hepatic veins
- DContinuous flow in IVC and hepatic veins
- EAscites
- Fsplenomegaly
- GBiphasic portal vein flow with dilated vein
- Hall of the above
88When varicies are formed secondary to portal HTN, which of the following is not a structure that should also be evaluated for varicies?
- Aleft ovary
- Bkidneys
- CGE junction
- Dspleen
89Which of the following is a contraindication to TIPS shunt placement?
- APortal vein thrombosis
- BChronic portal hypertension
- CChronic systemic hypertension
- DMetastatic disease
90Which two vessels does a TIPS usually connect?
- Aright portal vein to right hepatic vein
- Bmain portal vein to middle hepatic vein
- Cmiddle hepatic vein to right hepatic vein
- Dmain portal vein to right hepatic vein
91Which of the following is incorrect?
- Aproximal slenorenal shunt is also called a linton shunt
- Bdistal splenorenal shunt is also called a warren shunt
- Cmesocaval shunt connects SMV to IVC
- Dmesocaval shunt connects IMV to IVC
92Flow through the shunt cannot be evaluated for the first 3-5 days after surgery due to retained air limiting evaluation. When evaluating, the shunt should have velocities __-__ cm/s.
- A50-200
- B40-60
- C80-200
- D50-60
93Select all of the following that are signs of shunt failure:
- AAbsence of flow in shunt with occlusion
- BHepatopetal flow in the intrahepatic portal branches
- Chepatofugal flow in the main portal vein
- DChange in peak velocity since last exam: decreased >40cm/s or increased >60cm/s.
- Ereversal of flow in hepatic veins
- FRecanalization of umbilical vein
- Greappearance of varicies
- Hreaccumulation of ascites
- IFever
- Jelevated LFT
94Which of the following is not a contraindication for a liver transplant?
- AHepatitis C infection
- BHCC primary tumor >5cm
- Cmore than 3 primary tumors
- DMetastatic disease
95Which of the following is most important to assess for patency in liver transplant?
- AHepatic artery
- BBiliary tree
- CHepatic vein
- DPortal vein
96Which of the following is not a contraindication for liver transplant
- Aadvanced cardiopulmonary disease
- Bactive drug or alcohol abuse
- Ccompensated cirrhosis
- Dcholangiocarcinoma
- Ecurrent UTI
97Piggyback transplant connects ___________ while interposition connects ___________
- Adonor hepatic veins to native IVC, donor IVC to native IVC
- BDonor IVC to native IVC, donor hepatic veins to native IVC
- Cdonor portal vein to IVC, Donor IVC to native SMV
- DDonor SMV to IVC, Donor IVC to portal vein
98What describes the normal hepatic artery flow in a post transplant patient?
- APSV < 200 cm/s, antegrade through diastole, RI 0.5-0.7
- BPSV < 300cm/s, antegrade flow through diastole, RI 0.3-0.6
- CPSV > 200cm/s, antegrade flow through diastole, RI 0.5-0.7
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- Quiz on Liver, created by Ashley Spangler on 23/01/2021.
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- Ashley Spangler
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