Hagen: Textbook of Diagnostic Sonography, 7th Edition
Chapter 12: The Pancreas
Test Bank
MULTIPLE CHOICE
1. The majority of the pancreas lies within which abdominal cavity?
a. Perineum
b. Intraperitoneum
c. Retroperitoneum
d. Pericardium
ANS: C
The pancreas is located in the retroperitoneal cavity.
PTS: 1 REF: p. 302
OBJ: Describe the normal anatomy and relational landmarks of the pancreas.
TOP: Anatomy and physiology
2. The pancreas is found behind the ___________ omental sac.
a. Greater
b. Inferior
c. Superior
d. Lesser
ANS: D
The pancreas lies behind (posterior to) the lesser omental sac.
PTS: 1 REF: p. 301
OBJ: Describe the normal anatomy and relational landmarks of the pancreas.
TOP: Cross-sectional anatomy
3. Which one of the following statements is false?
a. The head of the pancreas is anterior to the inferior vena cava (IVC).
b. The head of the pancreas is superior to the caudate lobe.
c. The uncinate process is posterior to the superior mesenteric vessels.
d. The gastroduodenal artery is the anterolateral border of the head.
ANS: B
The head of the pancreas lies inferior to the caudate lobe of the liver and the main portal
vein.
PTS: 1 REF: p. 302
OBJ: Describe the normal anatomy and relational landmarks of the pancreas.
TOP: Cross-sectional anatomy
4. The head of the pancreas lies:
a. Anterior to the liver
b. Posterior to the aorta
c. Medial to the duodenum
d. Lateral to the inferior vena cava
ANS: C
The head of the pancreas lies medial to the duodenum (in the C-loop of the duodenum).
PTS: 1 REF: p. 302
OBJ: Describe the normal anatomy and relational landmarks of the pancreas.
TOP: Cross-sectional anatomy
5. The head of the pancreas is inferior to the _____________ of the liver:
a. Right lobe
b. Caudate lobe
c. Right lateral fissure
d. Left lateral fissure
ANS: B
The head of the pancreas is inferior to the caudate lobe of the liver and the main portal vein.
PTS: 1 REF: p. 302
OBJ: Describe the normal anatomy and relational landmarks of the pancreas.
TOP: Cross-sectional anatomy
6. The ___________ passes through a groove posterior to the pancreatic head.
a. Common bile duct
b. Gastroduodenal artery
c. Hepatic duct
d. Superior mesenteric vein
ANS: A
The common bile duct passes through the first part of the duodenum and courses through the
groove posterior to the pancreatic head.
PTS: 1 REF: p. 302
OBJ: Describe the normal anatomy and relational landmarks of the pancreas.
TOP: Anatomy and physiology
7. Which one of the following structures is located in the anterolateral border of the
pancreas?
a. Common bile duct
b. Gastroduodenal artery
c. Hepatic duct
d. Superior mesenteric vein
ANS: B
The gastroduodenal artery is located along the anterolateral border of the pancreas as it
travels a short distance along the anterior aspect of the pancreatic head just to the right of the
neck before it divides into the superior pancreaticoduodenal artery branches.
PTS: 1 REF: p. 309
OBJ: Describe the normal anatomy and relational landmarks of the pancreas.
TOP: Cross-sectional anatomy
8. The tail of the pancreas is located:
a. Posterior to the left kidney, near the splenic hilum
b. Anterior to the left kidney, near the splenic hilum
c. Posterior to the right kidney, near the liver hilum
d. Anterior to the right kidney, near the liver hilum
ANS: B
The tail of the pancreas lies anterior to the left kidney and posterior to the left colic flexure
and transverse colon.
PTS: 1 REF: p. 302
OBJ: Describe the normal anatomy and relational landmarks of the pancreas.
TOP: Cross-sectional anatomy
9. The primary pancreatic duct is the duct of ______________.
a. Santorini
b. Ampulla
c. Vater
d. Wirsung
ANS: D
The duct of Wirsung is a primary duct of the pancreas. It extends the entire length of the
gland.
PTS: 1 REF: p. 308
OBJ: Describe the normal anatomy and relational landmarks of the pancreas.
TOP: Anatomy and physiology
10. An older man with a history of alcoholism is recently diagnosed with acute pancreatitis.
His hematocrit and hypotension levels are decreased. Your differential diagnosis
includes:
a. Hemorrhagic pancreatitis
b. Cholecystitis
c. Pseudocyst
d. Chronic pancreatitis
ANS: A
Hemorrhagic pancreatitis may demonstrate symptoms that include a decrease in hematocrit
and serum calcium levels, severe (intense) abdominal pain radiating to the back, and
hypotension. Nearly one half of these patients have sudden necrotizing destruction of the
pancreas after an alcohol binge or an excessively large meal.
PTS: 1 REF: p. 308
OBJ: Define the clinical signs and symptoms of pancreatic disease.
TOP: Pathology
11. Which one of the following veins courses in a sagittal plane and passes posterior to the
neck of the pancreas?
a. Splenic
b. Superior mesenteric
c. Inferior mesenteric
d. Main portal
ANS: B
The superior mesenteric vein passes anterior to the third part of the duodenum and posterior
to the neck of the pancreas.
PTS: 1 REF: p. 302
OBJ: Describe the normal anatomy and relational landmarks of the pancreas.
TOP: Cross-sectional anatomy
12. A patient with painless jaundice, weight loss, and a decrease in appetite should be
evaluated for:
a. Cholecystitis
b. Adenocarcinoma of the pancreas
c. Pancreatitis
d. Pancreatic pseudocyst
ANS: B
Clinical findings of adenocarcinoma of the pancreas include weight loss, decreased appetite,
nausea and vomiting, stool changes, pain radiating to the back, painless jaundice, and
metastases.
PTS: 1 REF: p. 308
OBJ: Define the clinical signs and symptoms of pancreatic disease.
TOP: Pathology
13. The duct of Santorini is a(n):
a. Small accessory duct to the gallbladder
b. Accessory duct to the cystic duct
c. Accessory duct to the pancreas
d. Small opening in the duodenum
ANS: C
The duct of Santorini is a secondary duct that drains the upper most anterior pancreatic head.
PTS: 1 REF: p. 308
OBJ: Describe the normal anatomy and relational landmarks of the pancreas.
TOP: Anatomy and physiology
14. The normal dimension of the pancreatic head is usually less than ___________.
a. 3 mm
b. 2 cm
c. 2.4 cm
d. 1 cm
ANS: B
The head of the pancreas is the thickest part of the gland, measuring 2 to 3 cm.
PTS: 1 REF: p. 308
OBJ: Describe the normal anatomy and relational landmarks of the pancreas.
TOP: Anatomy and physiology
15. The normal size of the pancreatic duct is less than _____ mm.
a. 1
b. 3
c. 5
d. 6
ANS: B
The duct should measure less than 2 mm with tapering as it reaches the tail.
PTS: 1 REF: p. 308
OBJ: Describe the normal anatomy and relational landmarks of the pancreas.
TOP: Anatomy and physiology
16. A serum _____ level of twice normal usually indicates acute pancreatitis.
a. lipase
b. amylase
c. alkaline phosphatase
d. aspartate aminotransferase (AST)
ANS: D
A serum level of twice normal usually indicates acute pancreatitis. Lipase levels also increase
with acute pancreatitis.
PTS: 1 REF: p. 311
OBJ: Describe the laboratory test used to detect pancreatic disease.
TOP: Laboratory testing
17. The microscopic collection of cells within the tissues of the pancreas is called?
a. Glucagon cells
b. Islets of Langerhans
c. Insulin
d. Amylase cells
ANS: B
Islets of Langerhans are specialized cells that produce insulin (alpha cells), glycogen (beta
cells), and somatostatin (smallest delta cells).
PTS: 1 REF: p. 310
OBJ: Name the exocrine and endocrine functions of the pancreas.
TOP: Anatomy and physiology
18. The splenic vein courses along the ____________________ of the pancreas.
a. Anterior border
b. Along the superior border
c. Posteromedial border
d. Inferior posterior border
ANS: C
The splenic vein courses across the posteromedial surface of the pancreas to join the main
portal vein.
PTS: 1 REF: p. 309
OBJ: Describe the normal anatomy and relational landmarks of the pancreas.
TOP: Cross-sectional anatomy
19. If the celiac axis is well visualized, the sonographer should move the transducer in the
__________ direction to image the pancreas?
a. Superior
b. Anterior
c. Inferior
d. Posterior
ANS: C
The celiac axis serves as the superior border of the pancreas; therefore the sonographer
should move inferiorly to image the pancreas.
PTS: 1 REF: p. 308
OBJ: Describe the normal anatomy and relational landmarks of the pancreas.
TOP: Cross-sectional anatomy
20. The splenic artery is considered to be along the _________________ border of the
pancreas.
a. Superior
b. Lateral
c. Anterior
d. Inferior posterior
ANS: A
The splenic artery follows a tortuous course along the superior border of the pancreas.
PTS: 1 REF: p. 309
OBJ: Describe the normal anatomy and relational landmarks of the pancreas.
TOP: Cross-sectional anatomy
21. The main pancreatic duct joins the __________ before entering the second part of the
duodenum.
a. Common bile duct
b. Duct of Santolina
c. Cystic duct
d. Accessory duct
ANS: A
The duct of Wirsung enters the medial aspect of the second part of the duodenum with the
common bile duct at the ampulla of Vater.
PTS: 1 REF: p. 308
OBJ: Describe the normal anatomy and relational landmarks of the pancreas.
TOP: Anatomy and physiology
22. Clinical signs and symptoms in acute pancreatitis include all of the following except:
a. Severe abdominal pain radiating to the back
b. Severe abdominal pain radiating to the right shoulder
c. Elevated amylase
d. Nausea and vomiting
ANS: B
Clinical signs and symptoms of acute pancreatitis include sudden onset of moderate-to-
severe abdominal pain radiating to the back, nausea and vomiting, history of gallstones or
alcoholism, mild fever, increase in pancreatic enzymes (amylase and lipase), leukocytes, and
abdominal bloating.
PTS: 1 REF: p. 318
OBJ: Define the clinical signs and symptoms of pancreatic disease.
TOP: Pathology
23. A most common cause of acute pancreatitis in the United States is:
a. Colitis
b. Alcohol intake
c. Biliary tract disease
d. Pancreatic malignancy
ANS: C
The most common cause of acute pancreatitis is gallstone(s). Alcohol abuse is the second
most common cause.
PTS: 1 REF: p. 317
OBJ: Define the clinical signs and symptoms of pancreatic disease.
TOP: Pathology
24. The pancreas is reflective in its sonographic appearance because of the multiple:
a. Islets of Langerhans
b. Cooper ligaments
c. Small glands or acini
d. Fat between the lobules
ANS: D
The parenchymal texture of the pancreas depends on the amount of fat between the lobules
and, to a lesser extent, on the interlobular fibrous tissue.
PTS: 1 REF: p. 311
OBJ: Describe the sonographic technique and patterns of the normal pancreas.
TOP: Sonographic characteristics
25. What vessel runs posterior to the lower neck of the pancreas and anterior to the uncinate
process?
a. Splenic vein
b. Superior mesenteric vein
c. Gastroduodenal artery
d. Hepatic artery
ANS: B
The superior mesenteric vein crosses anterior to the uncinate process and posterior to the
neck and body of the pancreas.
PTS: 1 REF: p. 309
OBJ: Describe the normal anatomy and relational landmarks of the pancreas.
TOP: Cross-sectional anatomy
26. The persistence of the dorsal and ventral pancreas with the head encircling the duodenum
is called:
a. Hypoplasia
b. Cystic fibrosis
c. Agenesis
d. Annular pancreas
ANS: D
Annular pancreas is a rare anomaly in which the head of the pancreas surrounds the second
part of the duodenum. This condition is more common in men and may be associated with a
complete or partial atresia of the duodenum.
PTS: 1 REF: p. 309 OBJ: Name the congenital anomalies of the
pancreas.
TOP: Anatomy and physiology
27. A condition that causes increased secretion of abnormal mucus by the exocrine glands is:
a. Cystic fibrosis
b. Fibrocystic disease of the pancreas
c. Diabetes
d. Cystic mucosal disease
ANS: A
Cystic fibrosis is a hereditary disease that causes excessive production of thick mucus by the
endocrine glands.
PTS: 1 REF: p. 327
OBJ: Define the clinical signs and symptoms of pancreatic disease.
TOP: Pathology
28. Gallstones are present in 40% to 60% of patients with:
a. Chronic pancreatitis
b. Annular pancreas
c. Cystic fibrosis
d. Acute pancreatitis
ANS: D
Gallstones are present in 40% to 60% of patients with acute pancreatitis. Of the patients with
gallstones, 5% have acute pancreatitis.
PTS: 1 REF: p. 317
OBJ: List the sonographic findings and differential diagnoses of the following diseases:
pancreatitis, pancreatic cyst, and pancreatic tumors.
TOP: Pathology
29. A common course of enzyme destruction via the pancreas is the accumulation in the:
a. Greater omentum
b. Lesser omentum
c. Lesser sac
d. Greater sac
ANS: C
The common course is for fluid to break through the pancreatic connective tissue layer and
the thin posterior layer of the peritoneum and enter the lesser sac.
PTS: 1 REF: p. 317
OBJ: Describe the normal anatomy and relational landmarks of the pancreas.
TOP: Pathology
30. In cases of acute pancreatitis, the parenchyma of the pancreas generally appears:
a. Homogeneous
b. Echogenic
c. Calcified
d. Hypoechoic
ANS: D
Early stages of acute pancreatitis may appear sonographically normal. When swelling of the
pancreas occurs, the pancreas is hypoechoic to anechoic and is less echogenic because of the
increased prominence of lobulation and congested vessels.
PTS: 1 REF: p. 318
OBJ: List the sonographic findings and differential diagnoses of the following diseases:
pancreatitis, pancreatic cyst, and pancreatic tumors.
TOP: Sonographic characteristics
