Penny-ARDMS Abdomen Exam- Integration of Data Questions and Complete Solutions Graded A+, Exams of Medicine

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Penny-ARDMS Abdomen Exam- Intergration of Data Questions and Complete Solutions Graded A+ Denning [Date] [Course title]

b. Follicular carcinoma (Follicular carcinoma is not typically a primary cancer of the testicles. However, it is often a primary form of thyroid cancer.) - Answer: 1. A 35-year-old patient presents to the sonography department with a history of testicular cancer. Which of the following is not typically a primary cancer of the testicle? a. Choriocarcinoma b. Follicular carcinoma c. Seminoma d. Embryonal cell carcinoma b. Fatty infiltration (Given the patient's age and lack of symptoms, the sonographic findings are most indicative of fatty infiltration of the liver. Fatty changes within the liver can be diffuse or focal. Diffuse infiltration will cause the liver to appear diffusely echogenic and it will be more difficult to penetrate. Frequently, in the presence of diffuse fatty infiltration, the walls of the hepatic vasculature and diaphragm will not be easily imaged, secondary to the attenuation of the sound beam.) - Answer: 2. A 34-year-old obese, asymptomatic male patient presents to the sonography department with a history of elevated liver function labs. Sonographically, the liver appears diffusely echogenic, and the borders of the vessels are difficult to visualize. Which of the following would be the most likely diagnosis? a. Portal hypertension b. Fatty infiltration c. Budd-Chiari syndrome d. Hepatocellular carcinoma (HCC) d. Hepatitis (Patients with hepatitis can experience fever, chills, nausea, vomiting, fatigue, hepatosplenomegaly, dark urine, and jaundice. Elevation in the liver function tests is often apparent as well. Sonographically, a patient with hepatitis can have evidence of hepatomegaly and splenomegaly. As the liver enlarges, it tends to become more hypoechoic. Periportal cuffing may be seen in some patients with hepatitis. This is described as an increase in the echogenicity of the walls of the portal triads ("starry-sky" sign). The gallbladder wall may also be thickened.) - Answer: 3. A 44-year-old male patient presents to the sonography department for an abdominal sonogram complaining of fever, chills, dark urine, elevated liver function tests, and jaundice. Sonographically, the echogenicity of the portal vein walls appear increased, while the liver appears enlarged, and diffusely hypoechoic. The gallbladder wall also appears thickened. Which of the following would be the most likely diagnosis? a. HCC

b. Autosomal dominant polycystic kidney disease (ADPKD) c. Hemochromatosis d. Hepatitis d. Hepatomegaly (Patients with cirrhosis may have an elevation in aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase, and bilirubin. They may also present with jaundice, fatigue, weight loss, diarrhea, and ascites. While an initial enlargement of the liver can occur, with long- standing cirrhosis, the liver will become smaller.) - Answer: 4. Which of the following clinical findings would be least likely for the patient presenting with long-standing cirrhosis? a. Weight loss b. Jaundice c. Fatigue d. Hepatomegaly c. Cirrhosis (With cirrhosis, Patients may have laboratory abnormalities that include an elevation in AST, ALT, lactate dehydrogenase, and bilirubin. Patients may also present with jaundice, fatigue, weight loss, diarrhea, and ascites. Sonographic findings of cirrhosis include an echogenic, small right lobe, an enlarged caudate and left lobe, nodular surface irregularity, coarse echo texture, ascites, and splenomegaly.) - Answer: 5. A 58-year-old male patient presents to the sonography department for an abdominal sonogram with a history of an elevation in AST, ALT, lactate dehydrogenase, and bilirubin. He also has jaundice and complains of fatigue and weight loss. Sonographically, there is ascites within the abdomen and the right lobe of the liver appears small and echogenic. Which of the following is the most likely diagnosis? a. Hepatitis b. Budd-Chiari syndrome c. Cirrhosis d. Autosomal dominant polycystic liver disease b. Scanning the liver surface with a high-frequency linear transducer. (Cirrhosis caused by alcoholism will lead to the development of nodules that typically measure less than 1 cm, while cirrhosis caused by hepatitis will cause macronodular development, or nodules that measure between 1 and 5 cm. These nodules may be readily seen when ascites surrounds the liver. If ascites is not present, a high-frequency linear transducer can be used to analyze the liver surface for lumps.) -

Answer: 6. A patient presents with clinical findings highly suggestive of cirrhosis. The liver appears diffusely echogenic, but no ascites is seen. Which of the following would be most helpful in confirming the presence of cirrhosis? a. Have the patient perform the Valsalva maneuver while analyzing the portal veins. b. Scanning the liver surface with a high-frequency linear transducer. c. Perform the examination with a low-frequency transducer for increased penetration. d. Evaluate the liver postprandial. c. Left portal vein (With portal hypertension, the umbilical vein, which is associated with the left portal vein, ligamentum teres, and falciform ligament, becomes open again or recannlized, as it once was in utero, and shunts blood away from the liver and into the inferior epigastric veins or superior epigastric vein.) - Answer: 7. A 48-year-old patient with a history of cirrhosis is to be evaluated for sonographic signs of portal hypertension. Which of the following should be analyzed carefully? a. Right portal vein b. Middle hepatic vein c. Left portal vein d. Right hepatic vein d. Portal vein thrombosis (Patients with cirrhosis and portal hypertension have an increased risk for developing portal vein thrombosis. Thrombus can completely occlude the portal vein. In this case, the development of collaterals within the portal vein region will occur. These small vessels try to shunt blood around the clot. This results in a mesh of tiny blood vessels in the area of the portal vein, termed cavernous formation of the portal vein.) - Answer: 8. A 49-year-old female alcoholic patient presents to the sonography department for a liver sonogram with a history of cirrhosis and portal hypertension. She complains of abdominal pain, elevated liver function tests, and nausea and vomiting. Within the area of the porta hepatis, a mesh of tiny blood vessels are noted. What is the most likely cause for this finding? a. Amebic hepatic abscess b. Choledocholithiasis c. Hepatitis d. Portal vein thrombosis

a. Decreased liver function tests (Patients may complain of abdominal pain, low-grade fever, leukocytosis, hypovolemia, elevated liver function tests, and nausea and vomiting.) - Answer: 9. Which of the following is typically not a clinical finding in a patient who has portal vein thrombosis? a. Decreased liver function tests b. Hypovolemia c. Leukocytosis d. Low-grade fever b. Budd-Chiari syndrome (With Budd-Chiari syndrome, patients may suffer from extensive upper abdominal pain and elevated liver function test. Sonographic findings include the nonvisualization or reduced visualization of the hepatic veins. Thrombus may be noted within the hepatic veins, the caudate lobe may be enlarged, and color Doppler will often yield evidence of absent flow within the hepatic veins. The inferior vena cava may also be narrowed.) - Answer: 10. A 59-year-old patient with known HCC presents to the sonography department for a liver sonogram with upper abdominal pain and splenomegaly. Upon sonographic examination of the liver, the hepatic veins are not visualized and color Doppler yield evidence of absent flow in the area of the hepatic veins. Which of the following would be the most likely cause for these clinical and sonographic findings? a. Portal vein thrombosis b. Budd-Chiari syndrome c. Hepatitis d. Portal hypertension c. Hydatid liver cyst (Hydatid liver cysts are often discovered in people who live in sheep- and cattle- raising countries such as the Middle East, Australia, and the Mediterranean, or possibly in patients who have recently travelled to these areas. Clinically, patients present with a low-grade fever and right upper quadrant tenderness. Other signs and symptoms include nausea, obstructive jaundice, leukocytosis, and a slight raise in alkaline phosphatase.) - Answer: 11. A 32-year-old male patient presents to the sonography department for a liver sonogram with a history of a low-grade fever, right upper quadrant tenderness, and nausea. His laboratory findings include leukocytosis and an elevated alkaline phosphatase. He admits to have recently returned from a trip to the Middle East. Which of the following masses would be most likely discovered in this patient based on his clinical history? a. Hepatic candidiasis b. Hepatoma

c. Hydatid liver cyst d. Hepatic hematoma (Clinically, patients present with a low-grade fever and right upper quadrant tenderness. Other signs and symptoms include nausea, obstructive jaundice, leukocytosis, and a slight raise in alkaline phosphatase.)

• Answer: 12. Which of the following clinical findings is not suggestive of a hydatid liver cyst? a. Slight raise in alkaline phosphatase b. Recent trip to a sheep- or cattle-raising country. c. Leukocytosis d. Elevation in alpha-fetoprotein (AFP) c. Hypovolemia - Answer: 13. Which of the following would be the least likely clinical finding in a patient with a pyogenic hepatic abscess? a. Fever b. Leukocytosis c. Hypovolemia d. Right upper quadrant pain b. Hepatic amebic abscess (An amebic abscess comes from a parasite that grows in the colon and invades the liver via the portal vein. It is typically transmitted in contaminated water found in places like Mexico, Central America, South America, India, and Africa.) - Answer: 14. Which of the following would be most likely caused by drinking parasitic contaminated water? a. Hepatic candidiasis b. Hepatic amebic abscess c. Glomerulonephritis d. Pyogenic hepatic abscess b. Hepatic candidiasis (Patients who are immunocompromised can develop hepatic candidiasis. For example, cancer patients, recent organ transplant patients, or those with human immunodeficiency virus are prone to develop this

fungal abscess within their liver.) - Answer: 15. What hepatic abnormality may be discovered in the immunocompromised patient? a. Hepatic adenoma b. Hepatic candidiasis c. Focal nodular carcinoma d. Amebic hepatic abscess c. Multiple fungal candidiasis - Answer: 16. An 88-year-old immunocompromised patient presents to the sonography department for a liver sonogram with a history of right upper quadrant pain, fever, and hepatomegaly. Sonographically, multiple hyperechoic masses with hypoechoic borders are noted throughout the liver. Which of the following would be the most likely diagnosis? a. Multiple cavernous hemangiomas b. Multiple amebic hepatic abscesses c. Multiple fungal candidiasis d. Multiple hydatid liver cysts d. Hepatic candidiasis - Answer: 17. Which of the following is a result of a fungal disease invading the liver parenchyma? a. Pyogenic hepatic abscess b. Pheochromocytoma c. Hepatic hematoma d. Hepatic candidiasis a. Hepatic adenoma - Answer: 18. A 32-year-old female patient presents with a liver mass. She states that she has been using oral contraceptives for over 13 years. Which of the following would be most likely associated with oral contraceptive use? a. Hepatic adenoma b. Oncocytoma c. Hepatic lipoma d. Adenomyomatosis

c. Hepatic adenomas cause right upper quadrant pain. (Patients are typically asymptomatic with an adenoma.) - Answer: 19. Which of the following statements is not true concerning the hepatocellular adenoma? a. Hepatic adenomas do have the propensity to become malignant. b. Hepatic adenomas are linked with the use of oral contraception. c. Hepatic adenomas cause right upper quadrant pain. d. Hepatic adenomas may appear hypoechoic. c. Asymptomatic (Hepatic hemangiomas are usually incidentally detected and asymptomatic.) - Answer: 20. Which of the following would be the most common clinical complaint of a patient with a cavernous hemangioma of the liver? a. Right upper quadrant pain b. Nausea c. Asymptomatic d. Trauma b. Cavernous hemangioma - Answer: 21. A 29-year-old female patient presents to the sonography department for a right upper quadrant sonogram with a history of abdominal pain, nausea, and vomiting. Upon sonographic interrogation of the liver, a 2.5-cm hyperechoic mass is discovered within the right posterior segment of the liver. Which of the following would the most likely mass based on this patient's clinical history? a. Hepatic adenoma b. Cavernous hemangioma c. Focal nodular hyperplasia (FNH) d. Hepatoma d. FNH - Answer: 22. A 55-year-old asymptomatic female patient presents to the sonography department with a history of a mass discovered on a computerized axial tomography (CAT) scan within the liver. In the report, a central scar was noted. Which of the following tumors of the liver would be most likely to contain a central scar? a. Hepatic lipoma

b. Hepatic hemangioma c. Hepatic hematoma d. FNH d. Central scar - Answer: 23. A 44-year-old female patient presents to the sonography department for a right upper quadrant sonogram with a complaint of epigastric pain. The sonographic evaluation of the liver reveals an isoechoic mass within the right lobe that is difficult to image and discern its borders. You suspect that the mass is FNH. Which of the following sonographic findings would be most indicative of FNH? a. Abnormal borders b. Metastases c. Lack of internal vascularity d. Central scar c. Budd-Chiari syndrome - Answer: 24. Hepatomas that invade the hepatic veins causing narrowing of the hepatic veins, with subsequent tumor invasion into the inferior vena cava can produce symptoms of: a. Cushing syndrome b. Stein-Leventhal syndrome c. Budd-Chiari syndrome d. Conn syndrome b. Hepatoma (HCC (hepatoma) is most often seen in men, and frequently accompanied by cirrhosis or chronic hepatitis. HCC would be most likely suspected first, over metastasis, in this patient given his clinical history of cirrhosis. Clinically, patients with HCC will have abnormal liver function tests, signs of cirrhosis, unexplained weight loss, hepatomegaly, fever, and/or a palpable mass.) - Answer: 25. A 49-year-old alcoholic male patient presents to the sonography department for a right upper quadrant sonogram with a history of long-standing cirrhosis. He complains of unexplained weight loss and fever. The sonographic findings include a small, echogenic right lobe of the liver containing a solid 4-cm hypoechoic mass. Which of the following would be the most likely diagnosis? a. Metastasis b. Hepatoma c. Hepatic adenoma

d. Cavernous hemangioma b. AFP - Answer: 26. Which of the following laboratory tests can be used as a tumor marker for HCC? a. Lactate dehydrogenase b. AFP c. AST d. Prothrombin c. Hepatoma - Answer: 27. An elevated AFP levels is discovered in patients who have what tumor of the liver? a. Metastasis b. Hepatic adenoma c. Hepatoma d. FNH d. Weight gain - Answer: 28. Which of the following is not considered a common clinical feature associated with metastatic liver disease? a. Hepatomegaly b. Jaundice c. Right upper quadrant pain d. Weight gain c. Beckwith-Wiedemann syndrome - Answer: 29. Which of the following congenital syndromes has a noted tendency to developing the hepatoblastoma? a. Dandy-Walker syndrome b. Down syndrome c. Beckwith-Wiedemann syndrome d. Edward syndrome

d. Hepatoblastoma - Answer: 30. A 14-month-old male patient presents to the sonography department for a liver sonogram with Beckwith-Wiedemann syndrome and a clinical history of a palpable abdominal mass, elevated AFP level, and anorexia. Which of the following liver masses would most likely be discovered in this patient? a. Nephroblastoma b. Hemangioma c. Metastatic colon cancer d. Hepatoblastoma