1. Gallbladder and Biliary Tract Khristine Joy M. Calimlim-Carreon, MD

2. Case 1

3. Diagnosis A.Choledochal cyst type 1 B.Choledochal cyst type 2 C.Choledochal cyst type 3 D.Choledochal cyst type 4

4. Diagnosis A.Choledochal cyst type 1 B.Choledochal cyst type 2 C.Choledochal cyst type 3 D.Choledochal cyst type 4 P 1263

5. Characteristic A.Dilatation of the extrahepatic duct involving the common bile duct but may extend to the common hepatic duct B.Diverticulum of the extrahepatic bile duct C.Localized cystic dilatation of the distal, intramural duodenal portion of thr common bile duct D.Multiple cysts involving the intrahepatic and extrahepatic bile ducts

6. Characteristic A.Dilatation of the extrahepatic duct involving the common bile duct but may extend to the common hepatic duct B.Diverticulum of the extrahepatic bile duct C.Localized cystic dilatation of the distal, intramural duodenal portion of the common bile duct D.Multiple cysts involving the intrahepatic and extrahepatic bile ducts P 1263

7. Most precise way to confirm diagnosis A.Ultrasound B.CT scan C.Cholangiography D.MRI

8. Most precise way to confirm diagnosis A.Ultrasound B.CT scan C.Cholangiography D.MRI P 1266

9. What is single or multiple invovlement of the intrahepatic duct A.Choledochal cyst type 4A B.Choledochal cyst type 4B C.Caroli's disease D.Choledochocele

10. What is single or multiple invovlement of the intrahepatic duct A.Choledochal cyst type 4A B.Choledochal cyst type 4B C.Caroli's disease D.Choledochocele P 1263

11. Case 2

12. Diagnosis A.Gallbladder stone B.Cholesterol polyp C.Cholecystitis D.Bile sludge

13. Diagnosis A.Gallbladder stone B.Cholesterol polyp C.Cholecystitis D.Bile sludge P 1275

14. Sonographic finding: A.Hyperechoic focus with Posterior acoustic shadowing only B.Echogenic nonshadowing mural nodule C.Mural thickening of the gallbladder from subserosal edema D.Nonshadowing, Low to medium level echoes that layer in the dependent part of GB lumen

15. Sonographic finding: A.Hyperechoic focus with Posterior acoustic shadowing only B.Echogenic nonshadowing mural nodule C.Mural thickening of the gallbladder from subserosal edema D.Nonshadowing, Low to medium level echoes that layer in the dependent part of GB lumen P 1275

16. Complications of acute cholecystitis A.Gangrenous cholecystitis B.GB perforation & pericholecystic abscess C.Both A & B D.None of the above

17. Complications of acute cholecystitis A.Gangrenous cholecystitis B.GB perforation & pericholecystic abscess C.Both A & B D.None of the above P 1281 & 1285

18. Accuracy of imaging studies (ultrasound and cholescintigraphy) Exceed 70% Exceed 80% Exceed 90% Almost 100%

19. Accuracy of imaging studies (ultrasound and cholescintigraphy) Exceed 70% Exceed 80% Exceed 90% Almost 100% P 1279

20. Case 3

21. Diagnosis A.Hemorrhagic cholecystitis B.GB torsion C.Emphysematous cholecystitis D.Xanthogranulomatous cholecystitis

22. Diagnosis A.Hemorrhagic cholecystitis B.GB torsion C.Emphysematous cholecystitis D.Xanthogranulomatous cholecystitis P 1286

23. Organism most commonly associated A.Pseudomonas B.Klebsiella C.E.coli D.Staphylococcus

24. Organism most commonly associated A.Pseudomonas B.Klebsiella C.E.coli D.Staphylococcus P 1286

25. Sonograhic findings A.Intraluminal membranes, coarse intraluminal echoes, & focal mural irregularities B.Echogenic pericholecystic fluid collection C.Echogenic foci with reverberation artifacts or acoustic shadowing from the gallbladder lumen D.Marked distentiom of GB with course intraluminal echoes representing pus

26. Sonograhic findings A.Intraluminal membranes, coarse intraluminal echoes, & focal mural irregularities B.Echogenic pericholecystic fluid collection C.Echogenic foci with reverberation artifacts or acoustic shadowing from the gallbladder lumen D.Marked distentiom of GB with course intraluminal echoes representing pus P 1286

27. In what modality wherein there is difficulty in distinguishing intramural gas from porcelain GB with mural calcification? A.Plain abdominal radiograph B.CT scan C.Ultrasound D.None of the above

28. In what modality wherein there is difficulty in distinguishing intramural gas from porcelain GB with mural calcification? A.Plain abdominal radiograph B.CT scan C.Ultrasound D.None of the above P 1286

29. Case 4

30. Diagnosis A.Bronchobiliary fistula B.Choledochoduodenal fistula C.Choledocholonic fistula D.Choledochocutaneous fistula

31. Diagnosis A.Bronchobiliary fistula B.Choledochoduodenal fistula C.Choledocholonic fistula D.Choledochocutaneous fistula P 1317

32. Case 5

33. Diagnosis A.Hepatobiliary tuberculosis B.Primary sclerosing cholangitis C.Parasite within the biliary duct D.Bacterial cholangitis

34. Diagnosis A.Hepatobiliary tuberculosis B.Primary sclerosing cholangitis C.Parasite within the biliary duct D.Bacterial cholangitis P 1313

35. Sonographic findings A.Biliary stricture involving the porta hepatis level and less frequently the distal common bile duct B.Skip dilatation of the ducts C.Marked dilatation of the Common hepatic and common bile ducts that is filled with numerous parallel echogenic structures D.Marked thickening of the the duct wall in a concentric and diffuse distribution

36. Sonographic findings A.Biliary stricture involving the porta hepatis level and less frequently the distal common bile duct B.Skip dilatation of the ducts C.Marked dilatation of the Common hepatic and common bile ducts that is filled with numerous parallel echogenic structures D.Marked thickening of the the duct wall in a concentric and diffuse distribution P 1313

37. Most common parasite involve A.Ascaris lumbricoides B.Clonorchis sinensus C.Both A & B D.None of the above

38. Most common parasite involve A.Ascaris lumbricoides B.Clonorchis sinensus C.Both A & B D.None of the above P 1312