Sanders Exam Prep (Liver)
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Which of the following is a liver function test relatedto a blood clotting mechanism?
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Bilirubin level
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Aspartate aminotransferase (AST)
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Alanine aminotransferase (ALT)
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Prothrombin time
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Lactic acid dehydrogenase (LH)
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The Sanders Exam Prep (Liver) assesses knowledge of liver anatomy, physiology, and pathology. Topics include liver structure, vascular connections, and biochemical markers. Ideal for medical students or professionals preparing for exams.
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- 2.
The liver is an intraperitoneal organ surrounded byperitoneum. Which portion, if any, is NOT coveredby peritoneum?
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Right lobe
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Bare area
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It is all covered
Correct Answer
A. Bare areaExplanation
The correct answer is "Bare area". The liver is an intraperitoneal organ, meaning it is surrounded by peritoneum. However, the bare area of the liver is not covered by peritoneum. The bare area is a small portion on the posterior surface of the liver where it is in direct contact with the diaphragm, without any peritoneal covering.Rate this question:
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- 3.
With hepatopetal flow, the blood in the portal veinand the blood in the hepatic artery?
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Flows in the same direction
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Flows away from the liver
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Cannot be detected with Doppler
Correct Answer
A. Flows in the same directionExplanation
Blood in the normal portal vein and the
hepatic artery is detectable with Doppler. In both
vessels, the blood flows hi the same direction—hepatopetal
flow (i.e., toward the liver). Turbulence is
not a characteristic of the flow in either vessel.Rate this question:
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- 4.
The vessel that typically runs between the portalvein and the common bile duct is the??
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Hepatic artery
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Inferior vena cava
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Gastroduodenal artery
Correct Answer
A. Hepatic arteryExplanation
The hepatic artery normally runs between
the common bile duct and the portal vein.
It may have a tortuous course and usually bifurcates
proximal to the bifurcation of the common
hepatic duct.Rate this question:
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- 5.
A remnant of the fetal ductus venosus that dividesthe caudate lobe of the liver from the left lobe of theliver is the?
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Falciform ligament
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Ligamentum teres
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Ligamentum venosum
Correct Answer
A. Ligamentum venosumExplanation
In the fetus, the right branch of the umbilical
vein becomes the ductus venosus, which goes
into the inferior vena cava. After birth, the ductus
venosus becomes a fibrous cord called the ligamentum
venosum.Rate this question:
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- 6.
All of the following are characteristics of the hepaticveins EXCEPT?
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They branch away from the diaphragm
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They have echogenic walls
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They can be traced into the inferior vena cava
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All three are best seen on a transverse scan
Correct Answer
A. They have echogenic wallsExplanation
Hepatic veins do not have echogenic walls.Rate this question:
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- 7.
Which of the following is a rare malignant tumor,most commonly found in infants and children, thatcauses abdominal distention and hepatomegaly?
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Focal nodular hyperplasia
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Hepatoblastoma
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Hepatocellular carcinoma
Correct Answer
A. HepatoblastomaExplanation
Hepatoblastoma causes liver enlargement
and occurs in small children. Rhabdomyosarcoma
affects the same age-group, but most often
develops around the bladder. Hepatocellular carcinoma
is typically seen in an older population. Focal
nodular hyperplasia is a benign mass. A hematoma
is a benign, blood-filled mass secondary to trauma.Rate this question:
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- 8.
The vessel that is responsible for supplying the liverwith the most nutrients is the?
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Main portal vein
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Hepatic artery
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Hepatic vein
Correct Answer
A. Main portal veinExplanation
The main portal vein and the hepatic artery
are responsible for supplying the liver with oxygen
and nutrients; however, the main portal vein is the
larger contributor.Rate this question:
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- 9.
A casual reading of an abdominal sonogram in apatient with a Riedel's lobe could result in which ofthe following misdiagnoses?
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Hepatomegaly
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A mass in the head of the pancreas
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Hepatoma
Correct Answer
A. HepatomegalyExplanation
A Riedel's lobe is a long, thin extension of
the right lobe of the liver that can put the liver edge
well below the lower pole of the right kidney. Sonologists
using this criterion to make a diagnosis of hepatomegaly
will be guilty of not seeing the forest for
the trees—the entire liver must be taken into account.
The left lobe is often small in patients with a
Riedel's lobe, and patients with a small anteroposterior
diameter have livers that extend more inferiorly
to compensate. A Reidels lobe is unlikely to be
mistaken for any of the other options.Rate this question:
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- 10.
Choppy, triphasic flow patterns are seen in the
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Hepatic veins
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Hepatic arteries
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Portal veins
Correct Answer
A. Hepatic veinsExplanation
Because of their close proximity to the
right atrium, hepatic veins exhibit a pulsatile,
choppy flow. Normal portal veins have a nonpulsatile,
even flow. The hepatic arteries have a low-resistance
arterial pattern. In normal patients, the superior
mesenteric artery Doppler signal changes
from a high- to low-resistance arterial pattern when
the patient goes from a fasting to postprandial
state. The iliac veins do not normally pulsate, although
the veins vary with respiration.Rate this question:
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- 11.
A highly vascular, benign tumor in the liver is referredto as a?
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Hemangioma
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Hepatoma
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Hepatic adenoma
Correct Answer
A. HemangiomaExplanation
Hemangiomas are benign, vascular tumorsRate this question:
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- 12.
Serum glutamic pyruvic transaminase (SGPT) isalso referred to as?
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Alkaline phosphatase
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A-fetoprotein (AFP)
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Alanine aminotransferase (ALT)
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Bilirubin
Correct Answer
A. Alanine aminotransferase (ALT)Explanation
Alanine aminotransferase (ALT) is also
known as serum glutamic pyruvic transaminase
(SGPT). It is the most specific laboratory test for
liver function. ALT is an enzyme produced in the
hepatocytes, and there are high concentrations of
ALT in the liver.Rate this question:
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- 13.
A 30-year-old man is referred to ultrasound forgeneralized right upper quadrant tenderness andearly signs of jaundice. His gallbladder appearsnormal, but there are bright focal areas withoutshadowing scattered throughout his liver. Onclose inspection, these areas are seen to be thewalls of the portal vein branches. What is first inthe list of differential diagnoses?
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Hepatitis
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Choledocholithiasis
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Pneumobilia
Correct Answer
A. HepatitisExplanation
Jaundice brings to mind obstruction from
choledocholithiasis, but with an absence of gallstones
or shadowing throughout the liver a nonobstructive
cause should be considered. A subtle increase
in echogenicity of the portal triads is one of
the few sonographic indications of hepatitis; however,
this finding is not always present. It is possible
that the increase in periportal echogenicity is
caused by the decreased parenchymal echogenicity
sometimes seen in hepatitis. Pneumobilia would
cause linear echogenicity with dirty shadowing.
Choledocholithiasis would be seen as one or more
echogenic densities with acoustic shadowing.Rate this question:
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- 14.
A complex cystic area is seen in the liver. Which ofthe following patients, whose occupations arelisted, is MOST at risk to contract this condition?
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Shepherd
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Asbestos worker
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Carpenter
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Coal miner
Correct Answer
A. ShepherdExplanation
Shepherds are at risk for hydatid disease.
The eggs of this parasite are excreted in the feces
of infected animals, predominantly sheep, resulting
in humans becoming hosts. The liver is the
most common site for cyst development.Rate this question:
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- 15.
All of the following are possible causes of hyper-bilirubin-emiaEXCEPT??
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Severe cirrhosis
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Common duct stone
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Presbyductia
Correct Answer
A. PresbyductiaExplanation
Presbyductia is a term used to describe
the normal enlargement of the common bile duct
with age. Although hyperbilirubinemia is usually
associated with liver disease or biliary obstruction,
it can occur in the presence of destruction of red
blood cells, as in hemolytic anemia.Rate this question:
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- 16.
Fatty infiltration of the liver is associated with all ofthe following EXCEPT?
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Ethanol abuse (ETOH)
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Oral contraceptives
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Intravenous antibiotics
Correct Answer
A. Intravenous antibioticsExplanation
Of the choices listed, only intravenous
antibiotics are not a cause of fatty infiltration of the
liver. Isolated fatty infiltration of the liver is a benign,
reversible disorder that affects the hepatocytes
and may interfere with liver function.Rate this question:
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- 17.
Which of the following decreases in Hepatocellulardisease?
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Aspartate aminotransferase (AST)
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Alkaline phosphatase
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Vitamin K
Correct Answer
A. Vitamin KExplanation
VitaminKlevels decrease inhepatocellular
disease, resulting in a prolonged prothrombin time
(PT). Prolonged PT carries a poor prognosis, but can
revert to normal if the liver damage is reversed.Rate this question:
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- 18.
The porta hepatis contains all of the following EXCEPT??
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Glisson's capsule
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The sphincter of Oddi
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The portal vein
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The hepatic artery
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The common bile duct
Correct Answer
A. The sphincter of OddiExplanation
The sphincter of Oddi is at the entrance
of the common bile duct and pancreatic duct into
the duodenum; it does not lie in the porta hepatis.
Glisson's capsule refers to the fibrous tissue surrounding
the portal veins, bile ducts, and hepatic
arteries as they travel together in the liver. Glisson's
capsule also surrounds the liver. The common
hepatic duct becomes the common bile duct
at the point where it is joined by the cystic duct,
which is in the porta hepatis.Rate this question:
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- 19.
The vessel(s) in the liver that is(are) important indenning lobar anatomy for hepatic resection is(are)the?
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Inferior vena cava
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Hepatic arteries
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Hepatic veins
Correct Answer
A. Hepatic veinsExplanation
The hepatic veins define the separation
between the lobes and segments of the liver. The
umbilical vein is no longer patent after birth. There
is no portal artery. The portal vein and hepatic arteries
supply the liver with oxygen and nutrients but
do not separate the lobes. The inferior vena cava
does not separate the lobes of the liver.Rate this question:
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- 20.
In a patient with a highly echogenic liver, all of thefollowing laboratory values can help distinguishbetween cirrhosis and a normal liver EXCEPT?
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Liver function tests (LFTs)
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Acetylcholinesterase
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Alanine aminotransferase (ALT)
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Aspartate aminotransferase (AST)
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Gamma-glutamyltransferase (GGT)
Correct Answer
A. AcetylcholinesteraseExplanation
Acetylcholinesterase is not a laboratory value that can help distinguish between cirrhosis and a normal liver. Acetylcholinesterase is an enzyme that breaks down acetylcholine, a neurotransmitter. It is not specific to liver function and therefore would not be useful in differentiating between cirrhosis and a normal liver.Rate this question:
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- 21.
All of the following increase in hepatocellular diseaseEXCEPT??
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Bilirubin
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Acid phosphatase
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Prothrombin time (PT)
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Aspartate aminotransferase (AST)
Correct Answer
A. Acid phosphataseExplanation
Hepatocellular disease refers to liver cell damage or dysfunction. Bilirubin, prothrombin time (PT), and aspartate aminotransferase (AST) are all markers of liver function and can increase in hepatocellular disease. However, acid phosphatase is not specific to liver function and is not typically elevated in hepatocellular disease. Therefore, acid phosphatase is the exception among the given options.Rate this question:
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- 22.
Cirrhosis of the liver can be caused by all of the followingEXCEPT?
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Obstruction by cholelithiasis
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Diabetes mellitus
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Hepatitis B
Correct Answer
A. Diabetes mellitusExplanation
Cirrhosis of the liver is a chronic, progressive
disease caused by multiple factors that destroy the liver. Diabetes mellitus is caused by faulty insulin
production in the pancreas. If uncomplicated,
diabetes mellitus does not affect the liver.Rate this question:
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- 23.
All of the following are typical of long-standing cirrhosisEXCEPT?
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Hepatofugal flow of the portal veins
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A small liver
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An enlarged liver
Correct Answer
A. An enlarged liverExplanation
Cirrhosis is a fibrotic process that causes
the liver to shrink. An enlarged liver occurs in the
early stages of alcohol-related liver disease when
there is fatty infiltration or hepatitis. A nodular outline,
increased echogenicity, and hepatofugalflow of
the portal veins are all features of severe cirrhosis.Rate this question:
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- 24.
All of the following are features of portal hypertensionEXCEPT
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Hepatic artery thrombosis
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Splenomegaly
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Recanalization of the paraumbilical veins
Correct Answer
A. Hepatic artery thrombosisExplanation
Portal hypertension refers to an increase
in pressure in the portal venous system, usually
caused by liver disease or possibly portal vein
thrombosis. Hepatic artery thrombosis is not a
typical result of portal hypertension; however, the
portal vein often becomes thrombosed in portal
hypertension. Collaterals and splenomegaly result
from the pressure being reversed or forced to create
new paths.Rate this question:
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- 25.
A patient with end-stage cirrhosis exhibits hepatofugalportal flow, making the presence of collateralvessels likely. A close look at which of thefollowing will MOST easily demonstrate collateralflow?
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Ligamentum venosum
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Ligamentum teres
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Gallbladder region
Correct Answer
A. Ligamentum teresExplanation
Hepatofugal portal flow occurs in advanced
portal hypertension, a common sequel to
chronic cirrhosis. When sinusoidal resistance to
flow is so great that the direction of flow reverses,
portosystemic collaterals open up; the easiest to
detect is the recanalized paraumbilical vein that
travels in the ligamentum teres. To locate the paraumbilical
vein, find the ascending portion of the
left portal vein and follow the umbilical portion of
it inferiorly between the medial and lateral segments
of the left lobe of the liver. Color flow
Doppler will demonstrate flow and that the vein is
indeed recanalized.Rate this question:
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- 26.
A health care worker contracted hepatitis B from anaccidental needle stick. Which of the following isNOT likely to be seen on her abdominal sonogram?
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A hypoechoic liver
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A thickened gallbladder wall
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A lobular outline to the liver
Correct Answer
A. A lobular outline to the liverExplanation
This one is tricky I added it, but you will not be graded on this question. :)
A lobular outline to the liver is a feature
of cirrhosis, not hepatitis. Prominent portal vessels,
a thickened gallbladder wall, splenomegaly, and a
hypoechoic liver are all seen in hepatitis. Prominent
portal vessels, giving rise to the "starry night" appearance,are caused by edema of the liver.Rate this question:
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- 27.
A 23-year-old college student is referred by the universityhealth clinic because of diffuse abdominaland right upper quadrant pain. There is some freefluid in her abdomen and an encapsulated mass inher liver that is solid but contains complex cysticcomponents. The sonologist, quite correctly, makeshepatic adenoma the first differential diagnosis forall of the following reasons EXCEPT one. Which is it?**Will not be graded*** Hard question to get you thinking :)
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While ultrasound features are variable, hepatic adenomas often appear encapsulated
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Metastatic lesions in her liver would have a "bull's eye" appearance
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The cystic areas are compatible with bleeding inside the mass, as hepatic adenomas are prone to do
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Upon questioning, the patient reported having been on oral contraceptives since her freshman year
Correct Answer
A. Metastatic lesions in her liver would have a "bull's eye" appearanceExplanation
If a mass and ascites are discovered, it is
necessary to search carefully for metastases and
enlarged lymph nodes, treating the lesion as a
possible malignancy. However, in their absence,
this woman's history—especially the oral contraceptive
use—is appropriate for hepatic adenoma.
Hepatic adenomas are benign, so metastatic lesions
("bull's eye" or otherwise) would not be
present. The free fluid in her abdomen is from the
bleeding going on in her mass, which has ruptured
through the capsule into the peritoneum, irritating
it and causing her diffuse pain.Rate this question:
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- 28.
A preoperative ultrasound study reveals a solitaryliver mass displacing two structures in the liver.The surgeon is told he can confine his operation tothe medial segment of the left lobe. Which twostructures are being displaced?
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Ligamentum teres and gallbladder
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Fissure for the ligamentum venosum and left portal vein
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Left hepatic vein and middle hepatic vein
Correct Answer
A. Left hepatic vein and middle hepatic veinExplanation
The middle and left hepatic veins border
the medial segment of the left lobe of the liver. The
ligamentum teres separates the lateral and medial
segments of the left lobe at a more inferior level. A
mass that touches the gallbladder would have to
be in the right anterior lobe. The main portal vein
and hepatic duct are down by the porta hepatis.The left portal vein lies exclusively in the lateral segment of the left lobe, not the medial segment.Rate this question:
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- 29.
Hepatofugal flow may be indicative of all of thefollowing EXCEPT?
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A cirrhotic liver
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Portal hypertension
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Common bile duct obstruction
Correct Answer
A. Common bile duct obstructionExplanation
Common bile duct obstruction is not associated
with hepatofugal flow. Hepatofugal flow
occurs when the pressure in the portal system of
the liver is increased and blood cannot flow
through the portal vein. A reversal of the normal
direction of flow is detected with Doppler imaging;
however, a poor Doppler angle may create
false direction of flow.Rate this question:
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- 30.
The normal Doppler waveform of the portal veinis
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Biphasic
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Triphasic
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Monophasic
Correct Answer
A. MonophasicExplanation
The normal portal vein flows continuously
into the liver, which makes it a monophasic
waveform. Triphasic describes a waveform seen
particularly in the leg arteries and hepatic veins.Rate this question:
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- 31.
On which of the following views are all three hepaticveins BEST seen?
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Transverse, midliver
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Longitudinal, midline
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Longitudinal, adjacent to the aorta
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Transverse, close to the diaphragm
Correct Answer
A. Transverse, close to the diaphragmExplanation
A high transverse view close to the diaphragm
best shows the three hepatic veins. The
veins join the inferior vena cava just below the diaphragm.
Longtudinal views only show a single
vein.Rate this question:
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- 32.
Common conditions in which the gallbladder wallis thickened include all of the following EXCEPT***Think ***** This is a tough one!!!!Will not count if you get it wrong
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Fatty infiltration of the liver
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Hypoalbuminemia
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Acute cholecystitis
Correct Answer
A. Fatty infiltration of the liverExplanation
Isolated fatty infiltration of the liver is not
associated with gallbladder wall thickening. Acute
cholecystitis, AIDS, ascites, and hypoalbuminemia
all cause gallbladder wall thickening.Rate this question:
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- 33.
Which of the following vessels is associated withwaveforms that do NOT vary with respiration in anormal patient?
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Inferior vena cava
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Femoral vein
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Portal vein
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Jugular vein
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Hepatic vein
Correct Answer
A. Portal veinExplanation
The waveforms of the hepatic vein, jugular
vein, femoral vein, and inferior vena cava all vary
with respiration. Only the portal vein waveform
does not vary with respiration.Rate this question:
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- 34.
Which of the following statements concerningmetastatic lesions to the liver is TRUE?*Hard Question will not count in grading*
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Metastases in the gallbladder are from melanoma
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Metastases from the colon invariably appear as "bull's eye" lesions
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Color flow Doppler demonstrates if a tumor or metastatic lesion is vascular
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Lymphoma causes hypoechoic lesions in the liver
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One can never make a tissue-specific diagnosis from the sonographic appearance of a lesion
Correct Answer
A. One can never make a tissue-specific diagnosis from the sonographic appearance of a lesionExplanation
The first four answers are absolute statements:
melanomas frequently metastasize to the
gallbladder; colon metastases are sometimes "bull's
eye" lesions; color flow Dopplermay show vascular
flow; and lymphomatous lesions in the liver are
usually hypoechoic, but not always. Actually, this
was a trick question to ask after the cautionary tip
about "never" being in the answer. However, in
this case "never" means "not always," so it is stopping
you from making an absolute statement.Rate this question:
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Current Version
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Mar 21, 2023Quiz Edited by
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Nov 12, 2010Quiz Created by
KFeyler