Davies Review Questions For LIVER

34 Questions | By Agambino

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Questions and Answers

1.

You are scanning a patient with a known mass in the left medial segment of the liver. What anatomical landmark can you use to identify the left medial segment separate from the right anterior segment of the liver?

Discuss
- A.
  
  Left portal vein
- B.
  
  Ligamentum teres
- C.
  
  Ligamentum venosum
- D.
  
  Middle hepatic vein
- E.
  
  Left hepatic vein
2.

You suspect enlargement of the caudate lobe in a patient with liver disease. What structure located at the anterior border of the caudate lobe will help you identify this lobe of the liver?

Discuss
- A.
  
  Left portal vein
- B.
  
  Fissure for the ligamentum venosum
- C.
  
  IVC
- D.
  
  Fissure for the ligamentum teres
- E.
  
  Main lobar fissure
3.

You are asked to rule out the presence of a recannalized paraumbilical. Which anatomic structure is a useful landmark in location of this structure?
- A.
  
  Ligamentum teres
- B.
  
  Ligamentum venosum
- C.
  
  Coronary ligament
- D.
  
  Glissons ligament
4.

Which vessel courses with the main lobar fissure?
- A.
  
  Main portal vein
- B.
  
  Left portal vein
- C.
  
  Middle hepatic vein
- D.
  
  Proper hepatic artery
- E.
  
  Right hepatic vein
5.

Oxygenated blood is supplied to the liver via the :
- A.
  
  Portal vein and hepatic vein
- B.
  
  Hepatic vein and hepatic artery
- C.
  
  Portal vein and hepatic artery
- D.
  
  Hepatic artery only
6.

You are performing a sonogram on a slender female and notice a long, thin extension of the inferior aspect of the right lobe of the liver. This most likely represents:
- A.
  
  Caudate lobe
- B.
  
  Quadrate lobe
- C.
  
  Reidels lobe
7.

Which of the following forms the caudal border of the left portal vein?
- A.
  
  Ligamentum venosum
- B.
  
  Hepatodoudenal ligament
- C.
  
  Main lobar fissure
- D.
  
  Coronary ligament
- E.
  
  Ligamentum teres
8.

What ligament divides the left lobe of the liver into medial and lateral segments?
- A.
  
  Ligamentum venosum
- B.
  
  Main lobar fissure
- C.
  
  Ligamentum teres
9.

You are asked to perform a doppler study on the hepatic veins in the liver. What differentiates the hepatic veins from the portal veins?
- A.
  
  Hepatic veins converge toward the porta hepatis
- B.
  
  Hepatic veins have brightly echogenic walls
- C.
  
  Portal veins are largest near the dome of liver
- D.
  
  Portal veins normally exhibit a triphasic flow pattern
- E.
  
  Portal veins are accompanied by branches of the biliary tree and hepatic artery
10.

You have detected a mass anterior and to the left of the ligamentum venosum. This mass is located in what lobe of the liver?
- A.
  
  Left lobe
- B.
  
  Caudate lobe
- C.
  
  Right lobe
11.

The thin capsule surrounding the liver is known as:
- A.
  
  Reidels capsule
- B.
  
  Glissons capsule
- C.
  
  Teres capsule
12.

Which of the following course interlobar and intersegmental within the liver?
- A.
  
  Hepatic veins
- B.
  
  Portal veins
- C.
  
  Bile ducts
13.

You are performing an ultrasound exam of the liver on a small patient with a 5 MHz curved linear array. Although you have increased the overall gain to its maximum setting, the posterior border of the liver and diaphragm are not visualized, What should you do?

Discuss
- A.
  
  Rescan the liver with a lower frequency transducer
- B.
  
  Move the focal zone into the near field
- C.
  
  Decrease the transmit power on the ultrasound unit
14.

Which of the following correctly describes the probe placement and imaging plane you would use to demonstrate the 3 hepatic veins and IVC in one view?
- A.
  
  Subcostal oblique approach with the probe angled superiorly and to the patients right
- B.
  
  Sagittal subcostal approach with the probe just to the right of midline
15.

A patient is referred for a liver ultrasound with the clinical history of a raised serum alpha-fetoprotein level. What should you look for?
- A.
  
  HCC
- B.
  
  Fatty liver
- C.
  
  Focal nodular hyperplasia
16.

You are reviewing lab work prior to performing an abdominal ultrasound exam. Elevated lab values in GGT and ALP. Which statement is true?

Discuss
- A.
  
  Elevations in both of these lab values is highly specific for HCC
- B.
  
  Elevation of both ALP and GGT is a sensitive indicator of pancreatitis
- C.
  
  Concomitant elevation of both GGT and ALP indicates the source of the elevated ALP is the liver
17.

Which of the following lab tests is NOT used in the evaluation of liver function?
- A.
  
  GGT
- B.
  
  AST
- C.
  
  Lipase
- D.
  
  Direct bilirubin
- E.
  
  Indirect bilirubin
18.

A patient is referred with right upper quadrant pain and tenderness. Patient has a history of oral contraceptive use. A solid, hypoechoic mass is identified in the right lobe of the liver. Color doppler reveals hypervascularity of the mass. Which of the following scenarios is most likely?

Discuss
- A.
  
  Hepatic lipoma
- B.
  
  Hepatic adenoma
- C.
  
  Hepatic abscess
19.

A liver ultrasound on a 49 year old obese male demonstrates diffuse increased echogenicity with a focal hypoechoic area anterior to the portal vein. This most likely represents:
- A.
  
  Liver cirrhosis with HCC
- B.
  
  Fatty metamorphosis of the liver with focal sparing
- C.
  
  Metastatic disease most likely due to a colon primary
20.

A 52 year old male with known liver cirrhosis presents for an abdominal ultrasound. You will carefully evaluate the liver to rule out the presence of any focal mass because of which TRUE statement below?
- A.
  
  Patients with liver cirrhosis are at increased risk for hepatocellular carcinoma
- B.
  
  Metastatic disease occurs commonly with cirrhosis
- C.
  
  Patients with liver cirrhosis tend to develop multiple cysts in their liver and pancreas
- D.
  
  The presence of regenerative nodules rules out cirrhosis
- E.
  
  All the above are correct
21.

You are scanning a patient with suspected liver cirrhosis. All of the following are sonographic features of cirrhosis EXCEPT:
- A.
  
  Surface nodularity
- B.
  
  Shrunken caudate lobe
- C.
  
  Altered echo texture
- D.
  
  Ascites
- E.
  
  Regenerative nodules
22.

An ultrasound evaluation of liver cirrhosis should include a search for which associated complication?
- A.
  
  Biliary dilatation
- B.
  
  Mesenteric ischemia
- C.
  
  Portal hypertension
23.

Ultrasound findings of an abdominal study on a 51 year old female include enlargement of hepatic veins and IVC in an otherwise normal appearing liver. These findings are most consistent with which of the following?
- A.
  
  Liver cirrhosis
- B.
  
  Right sided heart failure
- C.
  
  Portal hypertension
24.

Focal fatty liver is most commonly found in which location?
- A.
  
  Medial to the ascending branch of the left portal vein
- B.
  
  Posterior to the right hepatic vein
- C.
  
  Adjacent tot he fissure for the ligamentum venosum
- D.
  
  Anterior to the portal vein at the porta hepatis
25.

You have performed an ultrasound study on a patient with enlarged caudate lobe. shrunken right lobe and splenomegaly. The hepatic veins could not be identified. No other abnormalities were discovered. What should you do?
- A.
  
  Have the patient return in a week for a repeat study to evaluate the hepatic veins
- B.
  
  Evaluate the hepatic veins and IVC with color doppler to confirm patency
- C.
  
  Nothing, you have completed the exam
- D.
  
  Have patient perform a valsalva maneuver and reexamine the hepatic veins
26.

A patient is referred to rule out hepatomegaly. All of the following are useful indicators of hepatomegaly EXCEPT:
- A.
  
  Rounding of the inferior border of the liver
- B.
  
  Longitudinal measurement of the right lobe exceeding 15.5 cm
- C.
  
  Extension of the right lobe inferior to the lower pole of the kidney
- D.
  
  Increased diameter of the main portal vein greater than 1 cm
- E.
  
  Increased anteroposterior measurement of the right lobe
27.

You have identified a single homogeneous hyperechoic lesion measuring 2.4 cm in the posterior aspect of the right lobe of the liver. What is the most common etiology of a mass fitting this description?
- A.
  
  Cyst
- B.
  
  Cavernous hemangioma
- C.
  
  Hepatic adenoma
- D.
  
  HCC
- E.
  
  Focal fatty sparing
28.

A patient is referred for a sonogram of the liver to rule out metastatic disease. Which of the following described the sonographic appearance of liver metastasis?
- A.
  
  Single hypoechoic mass
- B.
  
  Multiple hyperechoic masses
- C.
  
  Cystic masses
- D.
  
  All of the above appearances may be encountered with liver metastasis
- E.
  
  Masses of mixed echogenicity
29.

Which of the following is NOT a feature of hepatic cysts?
- A.
  
  Thin wall
- B.
  
  Posterior acoustic enhancement
- C.
  
  Anechoic
- D.
  
  Increased attenuation
- E.
  
  Increased through transmission
30.

You are scanning the liver and notice irregularity of the surface. A nodular liver surface is associated with which of the following abnormalities?
- A.
  
  Cirrhosis
- B.
  
  Hepatomegaly
- C.
  
  Fatty liver
- D.
  
  Acute hepatitis
31.

Which of the following is NOT TRUE regarding fatty liver?
- A.
  
  It is an irreversible disorder
- B.
  
  May be caused by obesity
- C.
  
  May be diffuse or focal
- D.
  
  May show a rapid change in appearance with time
- E.
  
  Commonly causes increased attenuation of the sound beam through liver
32.

The most common benign tumor in the liver is:
- A.
  
  Hepatic lipoma
- B.
  
  Hepatic adenoma
- C.
  
  Cavernous hemangioma
- D.
  
  Hepatoma
33.

You are scanning through the liver and notice luminal narrowing of the hepatic veins. Color and spectral doppler reveal high velocities through the strictures. These findings are most commonly associated with which of the following?
- A.
  
  Diffuse fatty liver
- B.
  
  Cirrhosis
- C.
  
  Glycogen storage disease
34.

Which of the following is most commonly associated with invasion of the portal vein?
- A.
  
  Hepatocellular carcinoma
- B.
  
  Hepatic adenoma
- C.
  
  Liver metastases

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