Abdomen: Gastrointestinal and Genitourinary I and II Flashcards
Which of the following radiographic signs relates to a pneumoperitoneum?
a. Poppyseed calcifications
b. Football sign
c. Bird-beak appearance
d. Double track sign
b. Football sign
Which of the following statements is correct regarding the renal disease characterized by the presence of grossly elongated, dilated collecting ducts throughout the renal parenchyma which resemble a cluster of straws when seen on end?
a. ureteral strictures are a common associated complication
b. the surface of the kidney remains smooth
c. the disease develops secondarily to a pyelonephritic infection
d. associated changes may include cystic involvement of the liver
d. associated changes may include cystic involvement of the liver
A supine KUB of a patient with gastric ulcer perforation demonstrates visualization of both the intraluminal and peritoneal surfaces of the bowel wall. Which of the following signs describes this appearance?
a. Football sign
b. Kirklin sign
c. String sign
d. Rigler’s sign
d. Rigler’s sign
Reflux of colon contents through the ileocecal is abnormal. During a lower GI study, it is normal to see contrast material in the ileum. What is the frequency of retro flow of contrast into the ileum during a lower GI study.
a. 10%
b. 40%
c. 70%
d. 90%
d. 90%
A thin, sharply demarcated lucent line with parallel straight margins at the base of an ulcer crater is called?
a. ulcer colla
b. Carmen’s line
c. Hampton line
d. Cresent sign
c. Hampton line
Following renal trauma, which imaging techniques offers physiologic information on renal function?
a. doppler ultrasound
b. retrograde pylogram
c. radionuclide urogram
d. abdominal CT
c. radionuclide urogram
Bowel obstruction during the immediate post-natal period, termed meconium ileus, is related to which of the following disorders?
a. Systemic lupus erythematosis
b. Inspissated milk syndrome
c. Cystic fibrosis
d. Hirsprong’s disease
c. Cystic fibrosis
The most common portion of the colon to be affected by adenocarcinoma is?
a. rectosigmond region
b. descending colon
c. transverse colon
d. ascending colon
a. rectosigmond region
What is the common benign ureteral tumor?
a. fibroepithelial polyp
b. leioyoma
c. papilloma
d. hemangioma
c. papilloma
Zenker’s divercilulum can be found where?
a. Superior-posterior esophagus
b. Superior-anterior esophagus
c. Mesenteric side of ileum
d. Anti-mesenteric side of ileum
a. Superior-posterior esophagus
Which of the following special imaging techniques is best utilized for the diagnosis of a cavernous hemangioma of the liver?
a. Spiral computed tomography with the administration of intravenous contrast and images taken in a hepatic arterial phase and a portal venous phase.
b. Catheterized administration of contrast into the SMA with computed tomography.
c. Magnetic resonance imaging of the liver utilizing T1 and T2 weighted images.
d. Radionuclide imaging of the liver.
a. Spiral computed tomography with the administration of intravenous contrast and images taken in a hepatic arterial phase and a portal venous phase.
Regarding pneumatosis intestinalis, which is false?
a. may be caused by bowel necrosis, ulceration or increased membrane permeability
b. findings include air bubbles in bowel wall on CT
c. it is not considered benign, even when asymptomatic
d. can be related to pulmonary origin
c. it is not considered benign, even when asymptomatic
Which of the following is not a cause of adynamic ileus?
a. Surgical manipulation
b. Electrolyte imbalance
c. Renal stones
d. Crohn’s disease
d. Crohn’s disease
A large, atonic bladder with little or no trabeculation, producing either incontinence or retention or urine is suggestive of…
a. Bladder diverticulum
b. Vesicoureteral reflux
c. Neurogenic bladder
d. Megacystica syndrome
c. Neurogenic bladder
Some consider crossed renal ectopia a variant of the horseshoe kidney. The ectopic kidney lies above the pelvis but on the wrong side. What frequency of the ectopic kidney being fused with the normal kidney?
a. never
b. 30%
c. 60%
d. 90%
d. 90%
It is thought that upper urinary tract calculi originate as ________ deep in the lining of the collecting ducts in the renal papillae which may detach and pass into the renal collecting system.
a. areas of nodular heterotopia
b. areas of acute focal pyelonephritis
c. Brucellosis infectious foci
d. Randall’s plaques
d. Randall’s plaques
A “cloverleaf deformity” is associated with:
a. tuberculosis
b. Crohn’s disease
c. Zollinger-Ellison disease
d. duodenal ulcer disease
d. duodenal ulcer disease
Which of the following is associated with the drooping lily appearance? a. ureteral duplication b. bifid renal pelvis c. ureteropelvic junction obstruction d. retrocaval ureter
a. ureteral duplication
What is a common location for gastric diverticulum to occur?
a. body
b. fundus
c. cardia
d. antrum
b. fundus
Complete loss the mucosal folds in the small intestine, seen in advanced sprue, is called what?
a. String sign
b. Mexican hat sign
c. Steppladder appearance
d. Moulage sign
d. Moulage sign
What is the most cause of large bowel obstrution?
a. Fecal impaction
b. Ischemia
c. Primary malignancies of the colon
d. Metastatic disease
c. Primary malignancies of the colon
Single or multiple deep ulcers of the esophagus associated with sinus tracts and fistula formation within the wall of the esophagus and extending to the mediastinum are common are characteristic of:
a. tuberculous esophagitis
b. herpes esophagitis
c. cytomegalovirus esophagitis
d. candida esophagitis
a. tuberculous esophagitis
Which characteristic listed below is not associated with ulcerative colitis?
a. starts distally and moves proximally through the colon
b. rarely involves the terminal ileum
c. eccentric disease
d. risk of toxic megacolon
c. eccentric disease
Dilated veins in the subepithelial connective tissue of the esophagus are most commonly a result of:
a. obstruction of the portal or splenic veins by carcinoma of the panceras
b. pancreatitis
c. slow-flow states (e.g. polycythemia)
d. portal hypertension
d. portal hypertension
Calcification of a fetus without involvement of the membranes is called….
a. Still birth rocky syndrome
b. Lithopedion
c. Dish baby syndrome
d. Ankylosing fetal syndrome
b. Lithopedion
Which of the following types of diverticuli arise in a relatively weak area on the left anterolateral wall of the esophagus between the inferior border of the aortic arch and the upper external margin of the left main bronchus and are only demonstrated on a right anterior oblique projection?
a. pulsion diverticuli
b. traction diverticuli
c. epiphrenic diverticuli
d. lateral diverticuli
a. pulsion diverticuli
Retrocardiac calcification in a retrocardiac esophageal mass is diagnostic of:
a. rhabdomyoma
b. adenomatous polyp
c. leiomyoma
d. squamous papilloma
c. leiomyoma
Dsyphagia in a person older than 40 years of age must be assumed to be ______ until proven otherwise?
a. Prebyesophagus
b. Esophageal webs
c. Carcinoma
d. Infectious/inflammatory esophagitis
c. Carcinoma
Rupture of berry aneurysms of the arteries at the base of the brain is associated with which renal cystic disease?
a. autosomal recessive polycystic kidney disease
b. autosomal dominant polycystic kidney disease
c. medullary sponge kidney
d. multicystic dysplastic kidney
b. autosomal dominant polycystic kidney disease
A kidney that crosses the midline is known as a(n):
a. ectopic kidney
b. subdiaphragmatic kidney
c. pelvic kidney
d. kidney malrotation
a. ectopic kidney
All of the following are causes of nephrocalcinosis except…
a. renal tubular acidosis
b. sarcoidosis
c. hypothyroidism
d. Wilson’s disease
c. hypothyroidism
Patients with massive localized rugal thickening along with hypoproteinemia and intestinal edema will often demonstrate which lab findings?
a. positive carcinoembryonic antigen and anemia
b. increased alkaline phosphatase and anemia
c. eosinophilia and anemia
d. positive blood cultures
c. eosinophilia and anemia
The “double bubble” sign relates to which of the following?
a. Duodenal atresia
b. Pneumoperitoneum
c. Sigmoid volvulus
d. Pyloric stenosis
a. Duodenal atresia
Which of the following characteristics is not associated with Crohn disease of the colon?
a. pseudodiverticula formation
b. fistula formation
c. rectal sparing
d. collar button ulcers
d. collar button ulcers
Which of the following is associated with bilateral engagement of the kidneys?
a. medullary sponge kidney
b. multicystic dyplastic kidney
c. autosomal recessive polycystic disease
d. none of the above
c. autosomal recessive polycystic disease
What is the most common solid mesenteric mass?
a. lymphoma
b. metastases
c. GIST
d. mesenteric desmoid
a. lymphoma
What is the most likely location to visualize an abdominal abscess?
A. Subphrenic space
B. Subhepatic space
C. Lesser sac
D. Pelvis
D. Pelvis
Brant & Helms Fundamental of Diagnostic Radiology p.663
A conventional radiographic examination of the abdomen demonstrates multiple mottled calcifications visualized on either side of the first lumbar vertebra. Which of the following should not be included in your differential diagnosis?
a. Chronic pancreatitis
b. Addison’s disease
c. Hydatid disease of the suprarenals
d. Nephrocalcinosis
C. Hydatid disease of the suprarenals
Brant & Helms Fundamental of Diagnostic Radiology p.662
Which of the following conventional radiographic examinations should be followed when a patient presents with an “acute abdomen”?
a. Erect PA chest, lateral decubitus chest, erect KUB
b. Erect PA chest, lateral decubitus chest, supine KUB
c. Erect PA chest, supine KUB, erect KUB
d. Erect PA chest, supine KUB, lateral decubitus abdomen
C. Erect PA chest, supine KUB, erect KUB
Brant & Helms Fundamental of Diagnostic Radiology p.656
What is the most common cause of toxic megacolon?
a. Pseudomenbranous colitis
b. Chron’s colitis
c. Ulcerative colitis
d. Ischemic colitis
C. Ulcerative colitis
Brant & Helms Fundamental of Diagnostic Radiology p.658
Which of the following represents an adrenal cortical tumor?
a. neuroblastoma
b. pheochromocytoma
c. adenoma
d. hemangioblastoma
C. adenoma
P&J 720
The most common cause of calcification of the adrenal glands is believed to be…
a. Dystrophism
b. Metabolic
c. Congenital
d. Hemorrhagic
d. Hemorrhagic
P&J
Which of the following is not true concerning adrenogenital syndrome?
a. usually occurs in newborns and infants who have an enzyme deficiency
b. associated with deficient production of cortisol and aldosterone and excess androgens
c. infants have adrenal hypoplasia masculinizing and feminizing syndromes
d. in older patients may be associated with adrenal neoplasm
c. infants have adrenal hypoplasia
b+h 3rd pg 868 infants have adrenal hyperplasia
Which of the following is not true concerning Addison disease?
a. requires destruction of only 10% of the adrenal cortex
b. most common cause in the U.S. is idiopathic
c. atrophy cases with adrenal calcification suggests prior tuberculosis or histoplasmosis
d. cases with adrenal enlargement suggest active infection
a. requires destruction of only 10% of the adrenal cortex
b+h 3rd pg 868 requires 90% destruction
Which of the following is not part of the rule of tens for pheochromocytoma?
a. 10% are unilateral
b. 10% are extra-adrenal
c. 10% are malignant
d. 10% are familial
a. 10% are unilateral
b+h 3rd pg b+h 3rd pg 868 10% are bilateral
Which of the following is not true concerning pheochromocytoma?
a. most arise in the adrenal cortex
b. most are larger than 2 cm in diameter
c. it is the most common adrenal tumor to hemorrhage spontaneously
d. extra-adrenal sites include the organ of Zuckerkandl, the bladder and para-aortic sympathetic chain
a. most arise in the adrenal cortex
b+h 3rd pg 868-9 most arise in the adrenal medulla
Which of the following is true concerning adrenal hyperplasia?
a. causes 70% of cases of non-iatrogenic Cushing syndrome
b. causes 20% of cases of Conn syndrome
c. may show adrenal limbs longer than 5 cm that exceed 10 mm in thickness
d. all of the above are true
d. all of the above are true
b+h 3rd pg 869
Which of the following is false concerning adrenal adenomas?
a. nonhyperfunctional adenomas found incidentally in 3-5% of the population
b. tend to be low in density on CT
c. tend to appear hypointense on T1 and hyperintense to liver on T2 compared to the liver
d. none of the above are false
d. none of the above are false
b+h 3rd pg 869
What is the most likely location to visualize an abdominal abscess?
- Subphrenic space
- Subhepatic space
- Lesser sac
- Pelvis
D. Pelvis
Brant & Helms Fundamental of Diagnostic Radiology p.663
A conventional radiographic examination of the abdomen demonstrates multiple mottled calcifications visualized on either side of the first lumbar vertebra. Which of the following should not be included in your differential diagnosis?
- Chronic pancreatitis
- Addison’s disease
- Hydatid disease of the suprarenals
- Nephrocalcinosis
C. Hydatid disease of the suprarenals
Brant & Helms Fundamental of Diagnostic Radiology p.662
Which of the following conventional radiographic examinations should be followed when a patient presents with an “acute abdomen”?
- Erect PA chest, lateral decubitus chest, erect KUB
- Erect PA chest, lateral decubitus chest, supine KUB
- Erect PA chest, supine KUB, erect KUB
- Erect PA chest, supine KUB, lateral decubitus abdomen
C. Erect PA chest, supine KUB, erect KUB
Brant & Helms Fundamental of Diagnostic Radiology p.656
What is the most common cause of toxic megacolon?
- Pseudomenbranous colitis
- Chron’s colitis
- Ulcerative colitis
- Ischemic colitis
C. Ulcerative colitis
Brant & Helms Fundamental of Diagnostic Radiology p.658
Which of the following represents an adrenal cortical tumor?
- neuroblastoma
- pheochromocytoma
- adenoma
- hemangioblastoma
C. adenoma
P&J 720
The most common cause of calcification of the adrenal glands is believed to be…
- Dystrophism
- Metabolic
- Congenital
- Hemorrhagic
D. Hemorrhagic
P&J
Which of the following is not true concerning adrenogenital syndrome?
- usually occurs in newborns and infants who have an enzyme deficiency
- associated with deficient production of cortisol and aldosterone and excess androgens
- infants have adrenal hypoplasia
- masculinizing and feminizing syndromes in older patients may be associated with adrenal neoplasm
C. Infants have adrenal hypoplasia
b+h 3rd pg 868
infants have adrenal hyperplasia
Which of the following is not true concerning Addison’s disease?
- requires destruction of only 10% of the adrenal cortex
- most common cause in the U.S. is idiopathic atrophy
- cases with adrenal calcification suggest prior tuberculosis or histoplasmosis
- cases with adrenal enlargement suggest active infection
A. requires destruction of only 10% of the adrenal cortex
b+h 3rd pg 868
requires 90% destruction
Which of the following is not part of the rule of tens for pheochromocytoma?
- 10% are unilateral
- 10% are extra-adrenal
- 10% are malignant
- 10% are familial
A. 10% are unilateral
b+h 3rd pg b+h 3rd pg 868
10% are bilateral
Which of the following is not true concerning pheochromocytoma?
- most arise in the adrenal cortex
- most are larger than 2 cm in diameter
- it is the most common adrenal tumor to hemorrhage spontaneously
- extra-adrenal sites include the organ of Zuckerkandl, the bladder and para-aortic sympathetic chain
A. most arise in the adrenal cortex
b+h 3rd pg 868-9
most arise in the adrenal medulla
Which of the following is true concerning adrenal hyperplasia?
- causes 70% of cases of noniatrogenic Cushing syndrome
- causes 20% of cases of Conn syndrome
- may show adrenal limbs longer than 5 cm that exceed 10 mm in thickness
- all of the above are true
D. all of the above are true
b+h 3rd pg 869
Which of the following is false concerning adrenal adenomas?
- non-hyperfunctional adenomas found incidentally in 3-5% of the population
- tend to be low in density on CT
- tend to appear hypointense on T1 and hyperintense to liver on T2 compared to the liver
- none of the above are false
D. none of the above are false
b+h 3rd pg 869
What is the most likely cause of an adrenal mass found incidentally?
- benign non-hyperfunctioning adenoma
- adenocarcinoma
- adrenal myelolipoma
- adrenal cyst
A. benign non-hyperfunctioning adenoma
b+h 3rd pg 869
Which of the following is false concerning adrenal myelolipomas?
- composed of bone marrow elements
- have 50% risk of malignant degeneration
- calcifications are present in 20% of cases
- range in size up to 30 cm
B. have 50% risk of malignant degeneration
b+h 3rd pg 870
adrenal myelolipomas have no malignant potential
Which of the following is not true concerning adrenal hemorrhage?
- most common in newborn infants
- trauma and infection are the most common causes in adults
- the left is more commonly affected in unilateral cases
- most cases in newborns are bilateral while unilateral cases are more common in adults
C. the left is more commonly affected in unilateral cases
b+h 3rd pg 870
right more often affected in unilateral cases
Which of the following is least likely to cause adrenal calcifications?
- adrenal hemorrhage
- adrenal myelolipoma
- pheochromocytoma
- benign adenoma
D. benign adenoma
b+h 3rd pg 871
Which of the following is not true concerning adrenal cysts?
- adrenal cysts are more common in men
- paracytic cysts are usually echinococcal in origin
- endothelial cysts tend to be multilocular with septal calcification
- hemorrhagic pseudocysts tend to be unilocular with wall calcification
- all of the above are true
A. adrenal cysts are more common in men
b+h 3rd pg 871
more common in women
What percentage of patients with malignant disease show adrenal metastases at autopsy?
- 3%
- 11%
- 27%
- 42%
C. 27%
b+h 3rd pg 871
Up to 50% of small adrenal masses in patients with a known primary malignancy are benign adenomas.
A. True
B. False
A. True
b+h 3rd pg 871
Which of the following is not true concerning adrenal carcinoma?
- most are large and invasive at presentation
- 50% are hyperfunctions and cause endocrine syndromes
- calcification is present in 30%
- signal intensity is hypointense relative to the liver on T2 images
D. signal intensity is hypointense relative to the liver on T2 images
b+h 3rd pg 871-2
signal is markedly hyperintense relative to liver on T2 images
Conn’s syndrome is associated with:
- a unilateral adrenal adenoma
- hyperplastic adrenals
- adrenal carcinoma
- ganglioneuroma
A. a unilateral adrenal adenoma
P&J pg. 720
Elevated levels of urine catecholamines are associated with:
- neuroblastoma
- pheochromocytoma
- ganglioneuroblastoma
- hemangioma
B. pheochromocytoma
P&J pg. 721
Which one of the following will most likely appear as an abdominal mass in a neonate?
- appendix abscess
- hemangioma
- teratoma
- neuroblastoma
D. neuroblastoma
Chapman 3rd p.198
Calcified adrenal glands may be secondary to which of the following…
- Dermoid cyst
- Cystic fibrosis
- Cushing’s disease
- Addison’s disease
D. Addison’s disease
P&J
Which of the following is not true concerning Cushing syndrome?
- caused by excessive amounts of aldosterone
- adrenal hyperplasia causes 70% of noniatrogenic cases
- 90% of hyperplasia cases are associated with microadenoma of the pituitary gland
- benign adrenal adenomas are responsible for 20% of noniatrogenic cases
A. caused by excessive amounts of aldosterone
b+h 3rd pg 868
caused by excessive amounts of hydrocortisone and corticosterone
remaining 10% of noniatrogenic cases caused by adrenal carcinoma
remaining 10% of hyperplasia cases caused by ectopic source of ACTH, usually lung malignancy
Which of the following is true concerning Conn syndrome?
- accounts for 50% of systemic hypertension cases
- hyperfunctioning adrenal adenoma is the cause of 20% of cases
- 80% of cases are caused by adrenal hyperplasia
- adenomas that produce Conn syndrome tend to be less than 2 cm in size
D. adenomas that produce Conn syndrome tend to be less than 2 cm in size
b+h 3rd pg 868
accounts for 1 to 2% of system hypertension
hyperfunctioning adenoma causes 80% of cases
adrenal hyperplasia account for 20% of cases
What is the most dependent portion of the abdominal cavity in a supine patient?
- Douglas’ pouch
- Morrison’s pouch
- Rectouterine pouch
- Rectovesicle pouch
B. Morrison’s pouch
Brant & Helms Fundamentals of Diagnostic Radiology p.651
Which of the following is a true statement regarding the compartmental anatomy of the
abdomen?
- There is constant communication between the right subphrenic space, right subhepatic space, right paracolic gutter, and Douglas’ pouch.
- There is constant communication between the left subphrenic space, left subhepatic space, left paracolic gutter, and Douglas’ pouch.
- There is constant communication between the right subphrenic space, right subhepatic space, left subhepatic space, left subphrenic space and Morrison’s pouch.
- There is constant communication between the left and right subphrenic spaces.
A. There is constant communication between the right subphrenic space, right subhepatic space, right paracolic gutter, and Douglas’ pouch.
Brant & Helms Fundamentals of Diagnostic Radiology p.651
Which of the following is not true concerning acute appendicitis?
- it is the most common cause of acute abdomen
- plain film shows appendiceal calculus in 14% of patients
- non-filling of the appendix is diagnostic for appendicitis
- appendix considered dilated when greater than 6 mm in diameter
C. non-filling of the appendix is diagnostic for appendicitis
b+h 3rd pg 861
non-filling of the appendix is of no diagnostic value
Which of the following is not true concerning appendiceal mucoceles?
- contain sterile mucus
- rupture may result in pseudomyxoma peritonei
- peripheral calcification may be present
- all of the above are true
D. all of the above are true
b+h 3rd pg 862
What is the most common tumor of the appendix?
- carcinoid
- adenocarcinoma
- adenoma
- mucinous cystadenoma
A. carcinoid
b+h 3rd pg 862
85% of appendiceal tumors
What is the most common location for carcinoid tumors?
- lung
- small bowel
- large bowel
- appendix
D. appendix
b+h 3rd pg 862
appendix accounts for 60% of all carcinoids
Appendiceal adenomas are usually associated with familial multiple polyposes:
A. True
B. False
A. True
b+h 3rd pg 863
Which of the following is not true concerning biliary duct dilatation?
- normal intrahepatic ducts should not exceed 40% of diameter of adjacent portal vein
- peripheral intrahepatic ducts are considered dilated when greater than 1.8mm in diameter
- central intrahepatic ducts are considered dilated when greater than 3 mm in diameter
- common bile duct is considered dilated when greater than 7mm
C. central intrahepatic ducts are considered dilated when greater than 3 mm in diameter
b+h 3rd pg 772
central ihbd’s dilated when greater than 2mm
Which is correct concerning biliary obstruction?
- gradual tapering of dilated common duct suggest malignant process
- abrupt termination of dilated common duct suggests benign stricture
- benign disease is responsible for 75% of cases of obstructive jaundice
- infected bile is present in 80% of complete biliary obstruction
C. benign disease is responsible for 75% of cases of obstructive jaundice
b+h 3rd pg 772
gradual tapering suggests a benign process; abrupt termination suggests malignant process; 10% of complete obstruction have infected bile
Which is not true concerning choledocholithiasis?
- responsible for 20% of cases of obstructive jaundice
- 1 to 3% of cases of choledocholithiasis have no stones in the gallbladder
- US is the most sensitive exam for stone detection
- associated signs on advanced imaging are “target sign” or “crescent sign”
C. US is the most sensitive exam for stone detection
b+h 3rd pg 772-3
mrcp and contrast ct are most sensitive 95-99%
us is 20-80%
noncontrast ct is 70-80%
Which is NOT true concerning benign stricture of the common bile duct?
- accounts for 45% of obstructive jaundice
- associated with previous stone passage
- duct wall enhances greatly during portal venous phase
- can follow radiation therapy to the area
C. duct wall enhances greatly during portal venous phase
b+h 3rd pg 773
enhances minimally if benign
hyperenhancement associated with malignant stricture
The patient presenting with a history of ulcerative colitis with small saccular outpouchings of the intrahepatic and extrahepatic duct walls most likely has:
- primary sclerosing cholangitis
- pancreatitis
- cholangiocarcinoma
- caroli disease
A. primary sclerosing cholangitis
b+h 3rd pg 773
Identify the false statement concerning Caroli’s disease:
- characterized by dilation of intrahepatic bile ducts
- associated with medullary sponge kidney
- associated with “central dot sign”
- most cases present in adulthood
D. most cases present in adulthood
b+h 3rd pg 774
Which type (according to Todani classification) of choledochal cyst is the most common?
- I
- II
- III
- IV
- V
A. I
b+h 3rd pg 774
I - fusiform dilation of CHD or CBD
II - diverticula of CHD or CBD with narrow connecting stalk
III - choledochoceles
IV - multifocal dilations of IHBDs and EHBDs
V - Caroli’s disease
Which is NOT true concerning cholangiocarcinoma?
- most are adenocarcinomas arising from bile duct epithelium
- second most common malignant primary hepatic tumor
- Klatskin tumor is a subtype occurring at the junction of the CBD and CHD
- extrahepatic cholangiocarcinoma is the most common subtype
C. Klatskin tumor is a subtype occurring at the junction of the CBD and CHD
b+h 3rd pg 775
klatskin tumor occurs at the junction of right and left hepatic ducts
90% are adenomas
extrahepatic form accounts for 65%
Cholecystoduodenal fistula is more common in women and caused by a perforating duodenal ulcer:
A. True
B. False
B. False
b+h 3rd pg 776
Gas in the biliary tree may follow sphincterotomy to facilitate stone passage:
A. True
B. False
A. True
b+h 3rd pg 776
What is the most common cause of bladder obstruction in older-aged males?
- Prostate carcinoma
- Benign prostatic hypertrophy
- Urethral valves
- Neurogenic dysfunction
B. Benign prostatic hypertrophy
P&J
Carcinoma of the bladder is usually of which type…
- Transitional cell
- Squamous cell
- Epithelial cell
- Basal cell
A. Transitional cell
P.&J.
A large, atonic bladder with little or no trabeculation, producing either incontinence or retention of urine is suggestive of…
- Bladder diverticulum
- Vesicoureteral reflux
- Neurogenic bladder
- Megacystica syndrome
C. Neurogenic bladder
P&J
Congenital enlargement of the bladder associated with hydronephrosis, hydroureter and
absence or hypoplasia of the abdominal muscles is called…
- Bladder ears
- Bladder exstrophy
- Prune-belly syndrome
- Agenetic abdominal syndrome
C. Prune-belly syndrome
P&J
When present, the ureteral jet phenomenon excludes the possibility of…
- Retrocaval ureter
- Ureterocele
- Ureteral diverculum
- Vesicoureteral reflux
D. Vesicoureteral reflux
P.&J.
- *Severe widening of the symphysis pubis can accompany which of the following bladder
disorders. ..**
- Duplication of the bladder
- Exstrophy of the bladder
- Agenesis of the bladder
- Bladder ears
B. exstrophy of the bladder
P.&J.
Cystitis cystica may progress to show mucous gland proliferation in the bladder wall. This
disease, which may be a precursor of bladder adenocarcinoma, is called:
- bullous edema
- emphysematous cystitis
- hemorrhagic cystitis
- cystitis glandularis
D. cystitis glandularis
b+h 3rd pg 900
Which of the following is true concerning the various types of cystitis?
- hemorrhagic cystitis is caused by a bacterial or adenovirus infection
- interstitial cystitis is a viral infection usually found in men
- bullous edema is associated with the use of indwelling catheters
- emphysematous cystitis may be seen in cases of poorly controlled diabetes mellitus
B. interstitial cystitis is a viral infection usually found in men
b+h 3rd pg 900
interstitial cystitis is an idiopathic inflammation usually found in women
Concerning calcification of the bladder wall and ureters, which is not true?
- schistosomiasis most commonly affects the distal ureters and bladder
- tuberculosis most commonly affects the proximal ureters
- 25% of bladder carcinomas calcify
- cystitis may cause curvilinear or flocculent bladder wall calcification
C. 25% of bladder carcinomas calcify
b+h 3rd pg 900-1
only 1-7% of bladder carcinomas calcify
A cobra head or spring onion appearance is suggestive of what diagnosis in the bladder?
- simple ureterocele
- ectopic ureterocele
- transitional cell carcinoma
- bladder stone
A. simple ureterocele
b+h 3rd pg 901
Ectopic ureteroceles are associated with incontinence in:
A. males
B. females
B. Females
What is the most common urinary tract neoplasm?
- transitional cell carcinoma of the bladder
- transitional cell carcinoma of the ureter
- renal cell carcinoma
- squamous cell carcinoma of the urethra
A. Transitional cell carcinoma of the bladder
b+h 3rd pg 901
tcc of the bladder is 50x more common than tcc of the ureter
What percentage of transitional cell carcinomas of the bladder have distant metastases at initial
diagnosis?
- 5%
- 15%
- 25%
- 40%
A. 5%
b+h 3rd pg 901
What percentage of transitional cell carcinomas of the bladder demonstrate calcifications?
- 1%
- 5%
- 15%
- 25%
B. 5%
b+h 3rd pg 903
Which of the following is least associated with squamous cell carcinoma of the bladder?
- presence of bladder stones
- chronic infection
- schistosomiasis
- tuberculosis
D. tuberculosis
b+h 3rd pg 903
tuberculosis associated with wall calcification
schistosomiasis highly associated with squamous cell carcinoma
Which of the following are not true for adenocarcinoma of the bladder?
- accounts for 15% of bladder malignancies
- associated with bladder exstrophy
- associated with urachal remnants
- none of the above are false
A. accounts for 15% of bladder malignancies
b+h 3rd pg 903
adenocarcinoma accounts for fewer than 1% of cases bladder malignancy
An irregular filling defect that moves with changes in patient position and changes size and shape with time is most suggestive of which diagnosis?
- bladder stones
- blood clots
- leiomyoma
- neurofibroma
B. blood clots
b+h 3rd pg 903
A pear-shaped bladder is suggestive of an extrinsic mass impression on the bladder by
pathologies including but not limited to lymphadenopathy, pelvic hemorrhage,
lipomatosis or aneurysm.
A. True
B. False
A. True
b+h 3rd pg 903
What is the most common location for bladder diverticula?
- anterolaterally
- anteromedially
- posterolaterally
- posteromedially
C. posterolaterally
b+h 3rd pg 903
near the ureterovesical junction
Match the fistula below with the most likely associated cause:
- vesicocolonic
- vesicovaginal
- vesicoenteric
- Crohn disease
- gynecologic surgery
- diverticulitis
- ulcerative colitis
- obstetric injury
- vesicocolic (large intestine and bladder) –> MC diverticulitis (60%) then colorectal cancer (20%) then Crohn’s (10%)
- vesicovaginal (colon - usually rectum and sigmoid - and vagina) –> MC complicated diverticular disease (20-40%); others include pelvic or colonic malignancies, inflammatory bowel disease and following pelvic radiotherapy
- vesicoenteric (colon and small bowel) –> MC Crohn’s
Which of the following is not true concerning bladder trauma?
- the distended bladder is more prone to injury than a collapsed bladder
- extraperitoneal rupture is less common than intraperitoneal rupture
- extraperitoneal bladder rupture most commonly extravasates to the retropubic space of Retzius
- intraperitoneal bladder rupture most commonly extravasates to the paracolic gutters
B. extraperitoneal rupture is less common than intraperitoneal rupture
b+h 3rd pg 904-5
A “hurley-stick ureter” is associated with:
- urinary bladder duplication
- bladder ears
- bladder exstrophy
- vesicoureteral reflux
C. Bladder exstrophy
P&J pg. 709
Incontinence or retention of urine is a complication of:
- malakoplakia
- neurogenic bladder
- bladder diverticula
- radiation cystitis
B. neurogenic bladder
P&J pg. 714
An hourglass bladder is a sign of:
- vesicoureteral reflux
- megaureter megacystis syndrome
- cystitis cystica
- neurogenic bladder
D. neurogenic bladder
P&J pg. 714
What is the most common benign tumor of the bladder?
- rhabdomyoma
- hemangioma
- leiomyoma
- nephrogenic adenoma
C. leiomyoma
Taveras Chpt 127, pg. 1
The major radiographic finding in bacterial cystitis is:
- bladder edema
- small hemorrhages in the bladder mucosa
- prominent thickened mucosal folds with a cobblestone appearance
- gas within the bladder wall
A. bladder edema
Taveras Chpt. 128, pg. 1
Which of the following statements regarding bladder diverticuli is true?
- bladder diverticuli represent protrusions of the bladder submucosa between the muscle fibers of the bladder
- most diverticuli are acquired because of bladder outlet obstruction or neurogenic bladder dysfunction in which intravesical pressure increase
- the most common location of diverticuli are at the inferior medial aspect of the bladder
- congenital diverticuli are most commonly multiple
B. most diverticuli are acquired because of bladder outlet obstruction or neurogenic bladder
Taveras, Chpt. 128, pg. 8
The most common cause of a pear-shaped or a tear-shaped bladder is:
- cystitis cystica
- vesical fistula
- endometriosis
- pelvic lipomatosis
D. pelvic lipomatosis
Taveras, Chpt. 128, pg. 10
“Hooking” of the distal ureters (a hockey-stick appearance) and significant elevation of the
bladder trigone is indicative of:
- bladder calculi
- benign prostatic hypertrophy
- urethral valves
- postoperative bladder-neck contracture
B. benign prostatic hypertrophy
Taveras, Chpt. 129, pg. 3, P&J pg. 712
What is the most common cause of vesicoureteral reflux in adults?
- urethral stricture
- median enlargement of the prostate
- neurogenic bladder dysfunction
- infection
D. infection
P & J pg. 714
The recommended imaging procedure of choice for differentiating bladder calculi from other
causes of calcification is:
- cystography, with air or diluted contrast medium
- CT pelvis with contrast
- retrograde pyelography
- MRI pelvis
A. cystography, with air or diluted contrast medium
P&J pg. 710
Which of the following is true concerning exstrophy of the bladder?
- the bladder mucosa is continuous with the skin
- there is an associated widening of the pubic symphysis
- there is an association with epispadias
- all of the above are true
D. all of the above are true
b+h 3rd pg 898
Which type of urachal remnant is most common?
- patent urachus
- umbilical-urachal sinus
- vesical-urachal diverticulum
- urachal cyst
A. patent urachus
b+h 3rd pg 898-9
patent urachus - 50%
urachal cyst - 30%
umbilical-urachal sinus - 15%
vesical-urachal divertuculum - 5%
Which of the following is false concerning urachal carcinoma?
- most are adenocarcinoma
- represents .5% of bladder carcinomas
- most common between the ages of 20 and 40
- none of the above are false
C. most common between the ages of 20 and 40
b+h 3rd pg 898-9
most common between 40 and 70
adenocarcinoma is 90% of cases
The normal wall of a well-distended bladder should not exceed:
- 3 mm
- 6 mm
- 9 mm
- 12 mm
B. 6 mm
b+h 3rd pg 899
J-hooking of the distal ureters is suggestive of which of the following?
- benign prostatic hypertrophy
- urethral stricture
- neurogenic bladder
- ectopic ureter insertion
A. benign prostatic hypertrophy
b+h 3rd pg 899
Which of the following is characterized by multiple fluid-filled submucosal cysts associated with bladder infection?
- cystitis cystica
- bullous edema
- interstitial cystitis
- eosinophilic cystitis
A. cystitis cystica
b+h 3rd pg 900
Cathartic colon most commonly involves the:
- entire colon.
- left colon.
- right colon.
- mesenteric small bowel.
C. right colon
Paul and Juhl’s, Essentials of Radiological Imaging, 7th ed., Lippincott, 1998, p. 616.
________ is a developmental rotation anomaly that results from clockwise rotation and results
in the transverse colon being positioned posterior to the duodenum, instead of its normal ventral location.
- Reversal of rotation
- Malrotation
- Double rotation
- Non-rotation
A. reversal of rotation
Paul and Juhl’s, Essentials of Radiological Imaging, 7th ed., Lippincott, 1998, p. 616.
The radiographic appearance of a cathartic colon includes all but one of the following?
- Appearance of UC
- Gaping ileocecal valve
- Narrowed right colon
- Ulcerations
D. ulcerations
Eisenberg 3rd ed. p.649
Computed tomography of an adult patient reveals a tubular cystic mass that demonstrates peripheral calcification in the right lower abdominal quadrant. This finding is associated with a round calcific density demonstrating a laminated pattern. Rupture of the previously described cystic mass would result in:
- hemorrhagic peritonei
- chylous ascites
- pseudomyxoma peritonei
- pseudochylous ascites
C. pseudomyxoma peritonei
Brant and Helms, Fundamentals of Diagnostic Radiology, 2nd ed., Lippincott, 1999, p.764.
Double-contrast barium enema on a 36-year-old female patient demonstrates a thumbprinting pattern of the proximal portion of the transverse colon. Computed tomography reveals thickening of the wall of the transverse colon, pneumatosis, and associated irregular lumen narrowing. The patient is currently on oral contraceptives and presented clinically with abdominal pain and bloody stools. Which of the following is most likely the correct diagnosis?
- Ulcerative colitis
- Crohn’s disease
- Necrotizing enterocolitis
- Ischemic colitis
D. Ischemic colitis
Paul and Juhl’s, Essentials of Radiological Imaging, 7th ed., Lippincott, 1998, p.622.
Brant and Helms, Fundamentals of Diagnostic Radiology, 2nd ed., Lippincott, 1999, p.759.
Which of the following represents a rare combination of intracerebral gliomas and colonic
polyps?
- Peutz-Jeghers syndrome
- Turcot’s syndrome
- Cronkhite-Canada syndrome
- Cowden’s disease
B. Turcot’s syndrome
Paul and Juhl’s, Essentials of Radiological Imaging, 7th ed., Lippincott, 1998, p.624.
Double-contrast barium enema of a 30-year-old male reveals innumerable filling defects
throughout the large bowel. The patient’s past medical history includes multiple dental caries,
localized bony overgrowth in the skull and osteomas. Which of the following best represents the course of action that should be taken in this patient’s case?
- Follow-up radiographs taken in six-month intervals should be performed to evaluate for increasing numbers of polyps.
- Biopsy of the polyps should be done to evaluate for malignant potential.
- The patient should be made aware of the findings and instructed to consume a high fiber diet.
- Total colectomy is warranted since there is almost a 100% risk of developing carcinoma in this patient’s condition.
D. Total colectomy is warranted since there is almost a 100% risk of developing carcinoma in this patient’s condition.
Eisenberg, Gastrointestinal Radiology, 1st ed., Lippincott, 1983, p. 715-717.
- *Barium enema in a 59-year-old male demonstrates a classic bilateral contour defect with ulcerated mucosa, eccentric and irregular lumen, and overhanging margins (“apple-core”
lesion) in the distal sigmoid colon. Clinical presentation includes crampy abdominal pain, rectal bleeding, and cachexia. Which of the following represents the best course of action in this patient’s case?**
- Intravenous glucagon should be administered to rule out the presence of sphincter spasm secondary to localized nerve and muscle imbalance.
- Nothing since this most likely represents normal bowel peristalsis.
- This patient most likely has carcinoma and CT of the abdomen should be ordered to evaluate for the presence of a second colorectal neoplasm and/or other distal metastases, such as to the liver.
- The findings in this patient most likely represent diverticulitis and he should follow-up with his medical doctor.
C. This patient most likely has carcinoma and CT of the abdomen should be ordered to evaluate for the presence of a second colorectal neoplasm and/or other distal metastases, such as to the liver.
Eisenberg, Gastrointestinal Radiology, 1st ed., Lippincott, 1983, p. 651-56.
Brant and Helms, Fundamentals of Diagnostic Radiology, 2nd ed., Lippincott, 1999, p.752-54.
Which one of the following hernias present with symptoms 75% of the time of intermittent
abdominal pain with occasional chest pain, cardiovascular symptoms and dyspnea?
- Hiatal
- Paraesophageal
- Morgagni
- Bockdalek
D. Bockdalek
Eisenberg 3rd ed. p.171
Which of the following is false about Gardner’s Syndrome?
- All patients develop colorectal carcinoma
- All patients present with osteomas
- All develop multiple hemangiomas of the colon
- All patients have a risk of developing small bowel carcinoma
C. All develop multiple hemangiomas of the colon
Eisenberg 3rd ed. p.508
The reflux of colon contents through the ileocecal valve is abnormal. During a lower GI study, it is normal to see contrast material in the ileum. What is the frequency of retro flow of contrast into the ileum during a lower GI study?
- 10%
- 40%
- 70%
- 90%
D. 90%
Eisenberg 3rd ed. p.555
The etiology of ulcerative colitis is unknown, some speculate that there is a connection to
connective tissue disorders and others speculate an infectious origin. Although the etiology is unknown the incidence of UC is higher among Caucasians, European Jews, and people living in developed countries. What age group is the peak incidence?
- 15-25 years
- 30-50 years
- 50 plus
- Bimodal 15-25 and 50 plus
D. bimodal 15-25 and 50 plus
Eisenberg 3rd ed. p.602
The radiographic description “bouquet of flowers” is used to describe which of the following?
- Colonic hamartoma
- Villous adenoma
- Villoglalandular polyp
- Hyperplastic polyp
B. Villous adenoma
Eisenberg 3rd ed. p.694
An ameboma is a focal hyperplastic granuloma caused by secondary bacterial infection of an
amebic abscess in the bowel wall. What percentage of patients with amebic colitis develop amebomas?
- less than 10%
- 50%
- greater than 90%
- There is no such thing as an ameboma
A. less than 10%
Eisenberg 3rd ed. p.701
A mother brings her child into your office and complains that little Trevor says his belly is sore. The child describes a classic colicky pain. On examination, you notice the patient have a mucocutaneous pigmentation. Seen in his mouth on his face, abdomen, hands and feet. What is the cause of colicky pain?
- Gallstone ileus
- Polyp
- Ulceration
- Ingestion of a foreign body
B. polyp
Eisenberg 3rd ed. p.722
Double tracking is the presence of longitudinal extraluminal tracts of barium paralleling the
lumen of the sigmoid colon. Which of the following does not exhibit this radiographic sign?
- Dissecting peridiverticulitis
- Crohn’s disease
- Carcinoma of the colon
- Ulcerative colitis
D. ulcerative colitis
Eisenberg 3rd ed. p.784-787
Although there are normal variations what is considered to be an enlarged retrorectal space
measurement?
- greater than 1.0cm
- greater than 1.5cm
- greater than 2.0 cm
- greater than 2.5cm
B. greater than 1.5 cm
Eisenberg 3rd ed. p.789
Almost 60% of large bowel obstructions are secondary to a primary carcinoma. What is the
second most common cause of large bowel obstruction?
- Volvulus
- Diverticulitis
- Fecal impaction
- Colonic bezoars
B. diverticulitis
Eisenberg 3rd ed. p.749
What is the most common location of colonic tuberculosis?
- Rectum
- Cecum
- Descending colon
- Hepatic flexure
B. cecum
Eisenberg 3rd ed. p.619
Toxic megacolon develops during relapses of chronic intermittent ulcerative colitis. Of all toxic
megacolon episodes what percentage are associated with UC?
- 25%
- 50%
- 75%
- 100%
C. 75%
Eisenberg 3rd ed. p.768
Which is the most common type of colonic polyp?
- Hyperplastic
- Adenomatous
- Hamartoma
- Villous adenoma
B. adenomatous
Eisenberg 3rd ed. p.684
Other than the appendix, where is the most common location for carcinoid tumors in the colon?
- Sigmoid colon
- Rectum
- Splenic flexure
- Hepatic flexure
B. rectum
Eisenberg 3rd ed. p.698,700
Air seen under the left diaphragm in a patient that is mentally retarded or psychotic patients
with chronic colonic enlargement is known as?
- Garrett superimposition
- Chilaiditi’s syndrome
- Saracens peritonitis
- Teutonic infection
B. Chilaiditi’s syndrome
Eisenberg 3rd ed. p.964
Crypt abscesses may be seen in association with:
- Crohn’s disease
- Whipple’s disease
- Ulcerative colitis
- Amebiasis
C. ulcerative colitis
Eisenberg, third edition p. 602
The clinical presentation of abrupt onset of lower abdominal pain and rectal bleeding in a
young woman taking birth control pills, which resolves radiographically in a few weeks is
characteristic of:
- Lymphogranuloma venereum
- Ischemic colitis
- Amebiasis
- Tuberculous colitis
B. ischemic colitis
Eisenberg, third edition p. 613
The most common extracolonic complication of amebiasis is:
- abdominal cramping
- muscular aches
- hepatic abscess
- severe septicemia
C. Hepatic abscess
Eisenberg, third edition p. 616
The Frei intradermal skin test can confirm a diagnosis of:
- actinomycosis
- Campylobacter fetus colitis
- Yersinia colitis
- lymphogranuloma venereum
D. lymphogranuloma venereum
Eisenberg, third edition p. 622
What is the most important cause of severe lower gastrointestinal bleeding in renal transplant recipients in whom immunosuppressant therapy has been initiated?
- cytomegalovirus
- strongyloidiasis
- staphylococcus
- chlamydia
A. cytomegalovirus
Eisenberg, third edition p. 624
The most common location of localized radiation injury in the colon is:
- ascending colon
- splenic flexure
- sigmoid colon
- rectum
D. rectum
Eisenberg, third edition p. 629
An uncommon multiple-system disease, characterized by ulcerations of the buccal and genital mucosa, ocular inflammation, and a variety of skin lesions, commonly presents with which of the following radiographic presentations?
- diverticuli
- skip lesions
- premalignant hyperplastic polyps
- fecal impaction
B. skip lesions
Eisenberg, third edition p. 634
- *Macrocephaly, pigmented genital lesions, and intestinal polyposis (Ruvalcaba-Myhre-Smith
syndrome) is also associated with which of the following:**
- accelerated psychomotor development in childhood
- prominent corneal nerves
- loss of fingernails and toenails
- brain tumors
B. prominent corneal nerves
Eisenberg, third edition p. 725
Exomphalos is:
- an asymptomatic condition with the small bowel on the right side of the abdomen and the colon on the left side
- a condition in which the colon lies dorsal to the SMA with the jejunum and duodenum anterior to it
- the duodenojejunal flexure lies to the right and caudad of its usual position which is to the left of the midline and approximately in the same axial plane as the 1st part of the duodenum
- total failure of the bowel to return to the abdomen from the umbilical cord
D. total failure of the bowel to return to the abdomen from the umbilical cord
Chapman 3rd, p. 204
Thumbprinting in the colon may be seen in association with:
- Yersinia enterocolitis
- polyarteritis nodosa
- radiotherapy
- pseudomembranous colitis
D. pseudomembranous colitis
Chapman, 3rd p. 248
In acute colonic obstruction, the possibility of perforation is likely when the cecum distends to
more than _____ cm?
- 3 cm
- 6.5 cm
- 10 cm
- 12 cm
C. 10 cm
Eisenberg 3rd p. 748
Barium enema demonstrates prominent mucosal edema with the surface being irregular and
“shaggy” secondary to diffuse superficial ulcerations. The patient has recently been on
antimicrobial drug therapy and was diagnosed with antibiotic colitis. Which of the following is
the most current term used to define this condition?
- Whipple’s Disease
- Granulomatosis Colitis
- Idiopathic Colitis
- Pseudomembranous Colitis
D. pseudomembranous colitis
Paul and Juhl’s, Essentials of Radiological Imaging, 7th ed., Lippincott, 1998, p. 618.
Which of the following systemic diseases is not considered a polyposis syndrome?
- Peutz-Jeghers
- Cronkhite-Canada
- Carcinoid
- Gardner’s
C. carcinoid
P.&J.
Most colonic malignancies are of this type…
- Adenocarcinoma
- Rhabdomyosarcoma
- Leiomyosarcoma
- Squamous cell carcinoma
A. adenocarcinoma
P.&J.
Which polyposis syndrome is not associated with malignant degeneration?
- Multiple polyposis syndrome
- Peutz-Jeghers syndrome
- Familial polyposis syndrome
- Cronkhite-Canada syndrome
D. Cronkhite-Canada syndrome
P.&J.
A second stage error of bowel rotation results in…
- Non-rotation
- Malrotation
- Mickel’s diverticulum
- Vitelline duct persistency
A. Non-rotation
P.&J.
The earliest sign of subdiaphragmatic abscess is…
- Pleural effusion
- Restricted hemidiaphragmatic motion
- Pneumoperitoneum
- Sentinel loops
B. Restricted hemidiaphragmatic motion
P&J
A cobblestone appearance of the mucosa at the gastric antrum and proximal duodenum is most suggestive of…
- Carcinoid tumor
- Squamous cell carcinoma
- Amyloidosis
- Crohn’s disease
D. Crohn’s disease
P&J
The “double bubble” sign relates to….
- Duodenal atresia
- Pneumoperitoneum
- Sigmoid volvulus
- Pyloric stenosis
A. Duodenal atresia
P.&J.
Triple bubble sign: jejunal atresia
Which is true concerning duodenal adenocarcinoma?
- 2nd most common malignant tumor of the duodenum
- most common in the duodenal bulb
- metastases to regional lymph nodes present in two-thirds of patients at presentation
- rarely seen in the periampullary region
C. metastases to regional lymph nodes present in two-thirds of patients at presentation
b+h 3rd pg 825
most common malignant tumor of the duodenum
rare in the duodenal bulb
most common in the periampullary region
Which is not true concerning duodenal adenoma?
- presents as a polypoid mass
- multiple polyps are seen in polyposis syndromes
- villous adenomas have a low incidence of malignant degeneration
- villous adenomas have a characteristic cauliflower appearance on double-contrast exams
C. villous adenomas have a low incidence of malignant degeneration
b+h 3rd pg 826
villous adenomas have a high rate of malignant degeneration
Which is not true concerning gastrointestinal stromal tumors in the duodenum?
- most commonly located in the second or third portion of the duodenum
- malignant tumors are more common in the proximal duodenum
- malignant tumors range up to 20cm in size
- malignant GIST is the second most common primary malignancy in the duodenum
B. malignant tumors are more common in the proximal duodenum
b+h 3rd pg 826
malignant tumors are more common distally
Which is not true concerning duodenal filling defects?
- Brunner gland hyperplasia/adenoma is associated with hyperacidity
- ectopic pancreas is the duodenum occurs most commonly in the proximal descending duodenum
- the appearance of areae gastrique in the duodenal bulb is associated with heterotopic gastric mucosa
- lymphoid hyperplasia in the duodenum is a precursor for lymphoma
D. lymphoid hyperplasia in the duodenum is a precursor for lymphoma
b+h 3rd pg 826-7
no evidence supports the connection between lymphoid hyperplasia and lymphoma
Which is not true concerning thickened duodenal folds?
- folds are considered to thicken when wider than 3 mm
- most common cause of duodenitis is h. pylori
- Crohn disease usually affects the first and second portion and is rarely associated with stomach involvement
- may be a normal variant
C. Crohn disease usually affects the first and second portion and is rarely associated with stomach involvement
b+h 3rd pg 827
Crohn involvement of the duodenum is almost always associated with contiguous
stomach involvement
Which statement is false concerning duodenal ulcers?
- most are associated with h. pylori infection
- most occur in the anterior wall of the duodenal bulb
- most are larger than 2 cm
- post-bulbar ulcers are characteristic of Zollinger-Ellison syndrome
C. most are larger than 2 cm
b+h 3rd pg 827-8
most are smaller than 1 cm
Which is false concerning duodenal diverticulum?
- usually incidental finding
- most common along inner aspect of the ascending duodenum
- differentiated by change in appearance during peristalsis
- intraluminal diverticula are congenital and have a windsock configuration
B. most common along inner aspect of the ascending duodenum
b+h 3rd pg 828-9
most common along inner aspect of descending duodenum
Which is false concerning duodenal narrowing?
- annular pancreas causes congenital narrowing of the descending duodenum
- postbulbar ulcer is associated with narrowing of the second and third portion of the duodenum
- ulceration is rare in circumferential duodenal adenocarcinoma
- duodenal narrowing may result from inflammation in the pancreas
C. ulceration is rare in circumferential duodenal adenocarcinoma
b+h 3rd pg 829-30
ulceration is common in duodenal adenocarcinoma
The most common cause of upper GI bleed is:
- duodenal ulcer
- esophageal varices
- gastric ulcer
- mallory-weiss tear
A. duodenal ulcer
b+h 3rd pg 830
Adenocarcinoma constitutes 80%-90% of all duodenal malignancies. What is the most common location for the tumor?
- Just distal to the pyloric sphincter
- At or proximal to the ampulla of Vater
- At or distal to the ampulla of Vater
- Localized in the duodenal bulb
C. at or distal to the ampulla of Vater
Eisenberg 3rd ed. p.407
The most common cause of duodenal fold thickening is:
- Zollinger-Ellison syndrome
- Whipple’s disease
- peptic ulcer disease
- eosinophilic enteritis
C. peptic ulcer disease
Eisenberg, third edition p. 337
A central collection of barium (dimple) within a smooth, well-demarcated filling defect in the
duodenum, representing the filling of miniature duct-like structures, is associated with:
- prolapsed antral mucosa
- papilla of Vater
- Crohn’s disease
- ectopic pancreas
D. ectopic pancreas
Eisenberg, third edition p. 378
Malignant tumors of the duodenum are most commonly found in which portion?
- first
- second
- third
- fourth
D. fourth
Eisenberg, third edition p. 384
Small hamartomatous polyps resulting in single or multiple filling defects in the duodenum are
associated with:
- Turcot syndrome
- Peutz-Jeghers syndrome
- Carcinoid tumor
- Gardner’s syndrome
B. Peutz-Jegher’s Syndrome
Eisenberg, third edition p. 387
Frostberg’s inverted sign of three is most commonly associated with:
- acute pancreatitis
- pancreatic carcinoma
- ectopic pancreatic pseudocyst
- choledochal cyst
A. acute pancreatitis
Eisenberg, third edition p. 357
A cystic dilatation of the intraduodenal portion of the common bile duct in the region of the
ampulla of Vater is known as:
- duplication cyst
- choledochocele
- prolapsed antral mucosa
- ectopic pancreas
B. choledochocele
Eisenberg, third edition p. 381
A “cloverleaf deformity” is associated with:
- tuberculosis
- Crohn’s disease
- Zollinger-Ellison disease
- duodenal ulcer disease
D. duodenal ulcer disease
Eisenberg, third edition p. 403
Which portion of the duodenum is intraperitoneal?
- first
- second
- third
- fourth
A. first
b+h 3rd pg 817
Which of the following is not true concerning tumors in the duodenum?
- 90% of duodenal bulb tumors are benign
- 50% of tumors in the second portion of the duodenum are benign
- 30% of tumors in the third portion of the duodenum are malignant
- most tumors in the fourth portion of the duodenum are malignant
C. 30% of tumors in the third portion of the duodenum are malignant
b+h 3rd pg 825
50% are malignant in the 3rd portion
Esophageal narrowing, buccal contractures, esophageal blebs, and characteristic blisters of
the mucous membranes can be seen in which of the following?
- Radiation injury
- Graft-versus-host disease
- Epidermolysis bullosa
- Sclerotherapy
C. epidermolysis bullosa
Eisenberg 3rd ed. p.91
Barrett’s adenocarcinomas comprise _____ of all esophageal cancers.
A. less than 5%
B. 10% to 20%
C. 50%
D. 75% to 90%
B. 10-20%
Paul and Juhl’s, Essentials of Radiological Imaging, 7th ed., Lippincott, 1998, p 558.
Brant and Helms, Fundamentals of Diagnostic Radiology, 2nd ed., Lippincott, 1999, p 714.
Thrombosis in the superior vena cava may lead dilatation of upper esophageal collateral veins
and is referred to as_______.
- downhill varices
- post-thrombotic esophageal varices
- uphill varices
- caval thrombosis syndrome
A. downhill varices
Paul and Juhl’s, Essentials of Radiological Imaging, 7th ed., Lippincott, 1998, p.563.
downhill is less common
Uphill varices (MC) –> portal hypertension (MC cause liver cirrhosis)
An upper gastrointestinal study shows a smooth, well-defined filling defect, demonstrating
obtuse mucosal angles, within the esophagus. Computed tomography of the same patient
shows this lesion to be an intramural mass of soft tissue density with focal areas of
calcification. Which of the following best represents the most likely diagnosis?
- Lipoma
- Fibroepithelial polyp
- Fibrovascular polyp
- Leiomyoma
D. Leiomyoma
Brant and Helms, Fundamentals of Diagnostic Radiology, 2nd ed., Lippincott, 1999, p.719.
Which of the following best represents an area of pharyngeal mucosa protrusion through weak
areas of the lateral aspect of the esophagus near the tonsillar fossa and thyrohyoid membrane,
and are seen most commonly in wind instrument players secondary to increased
intra-pharyngeal pressure?
- Zenker’s diverticulum
- Lateral pharyngeal Diverticulum
- Epiphrenic diverticulum
- Sacculation
B. Lateral pharyngeal diverticulum
Brant and Helms, Fundamentals of Diagnostic Radiology, 2nd ed., Lippincott, 1999, p.712.
If a patient has Killian’s dehiscence what are they susceptible to developing?
- Zenker’s diverticulum
- Esophageal varices
- Carcinoma of the esophagus
- Achalasia
A. Zenker’s diverticulum
Eisenberg 3rd ed. p.6, 119
A patient is brought into your clinic complaining of dysphagia. He reports having had pneumonia last winter and since feels very week. He has also recently been diagnosed with having cataracts. What is the diagnosis?
- Parkinson’s
- Multiple sclerosis
- Myasthenia gravis
- Scleroderma
C. Myasthenia gravis
Eisenberg 3rd ed. p.7
What is the reverse figure 3 or “figure E” impression on a barium filled esophagus is a sign of?
- Varicosities
- Normal finding
- Coarctation of the aorta
- Double aortic arch
C. Coarctation of the aorta
Eisenberg 3rd ed. p.35
The most common cause of esophageal ulceration is due to?
- Gastric or duodenal reflux
- Candida albicans
- Tuberculosis
- Ingestion of corrosive agents
A. gastric or duodenal reflux
Eisenberg 3rd ed. p.45
Dysphagia in a person older than 40 years of age must be assumed to be _____ until proven
otherwise?
- Presbyesophagus
- Esophageal webs
- Carcinoma
- Infectious/inflammatory esophagitis
C. Carcinoma
Eisenberg 3rd ed. p.76
What is the 5-year survival rate for “early esophageal cancer” defined as limited to mucosa or submucosa without lymphatic metastases?
- 10%
- 30
- 60
- 90%
D. 90%
Eisenberg 3rd ed. p.79
Of the congenital tracheoesophageal fistulas, Type II and Type III are the most common forms and produce identical symptoms. Which of the following radiographic studies can differentiate the two entities?
- Cervical films
- Thoracic films
- KUB
- Chest
C. KUB
Eisenberg 3rd ed. p.132
Which of the following demonstrates a premalignant skin disorder characterized by
papillomatosis, pigmentation and hyperkeratosis which also produces a radiographic appearance of a finely nodular filling defect throughout the esophagus?
- Acanthosis nigricans
- Melanoma
- Benign mucous membrane pemphigoid
- Dermatomyositis
A. Acanthosis nigricans
Eisenberg 3rd ed. p.148
Dilated veins in the subepithelial connective tissue of the esophagus are most commonly a
result of:
- obstruction of the portal or splenic veins by carcinoma of the pancreas
- pancreatitis
- slow-flow states (eg. polycythemia)
- portal hypertension
D. Portal hypertension
Eisenberg, third edition p. 125
A pulsion diverticulum at a point of anatomic weakness at Killian’s dehiscence is known as:
- traction diverticula
- Zenker’s diverticula
- Epiphrenic diverticula
- Meckel’s diverticula
B. Zenker’s diverticula
Eisenberg, third edition p. 119
- *Diverticula of the thoracic portion of the esophagus are most commonly found in which
location: **
- upper third
- middle third
- lower third
- at the lower esophageal sphincter
B. middle third
Eisenberg, third edition p. 121
Which of the following types of diverticula arise in a relatively weak area on the left anterolateral wall of the esophagus between the inferior border of the aortic arch and the upper external margin of the left main bronchus, and are only demonstrated on a right anterior oblique projection?
- pulsion diverticuli
- traction diverticuli
- epiphrenic diverticuli
- lateral diverticuli
A. pulsion diverticula
Eisenberg, third edition p. 122
Which of the following esophageal diverticuli are associated with motor abnormalities of the
esophagus and are probably related to incoordination of esophageal peristalsis?
- intraluminal diverticuli
- epiphrenic diverticuli
- traction diverticuli
- lateral diverticuli
B. epiphrenic diverticuli
Eisenberg, third edition p. 122
Strictures of the esophagus can appear as soon as ______________ after the ingestion of a
caustic substance?
- 2 hours
- 2 days
- 2 weeks
- 2 months
C. 2 weeks
Eisenberg, third edition p. 85
An ascending or migrating esophageal stricture, in which there is a progressive upward extension of both the squamocolumnar junction and the level of the stricture on serial examination, is associated with an increased risk of:
- squamous cell carcinoma
- adenocarcinoma
- actinomycosis
- cytomegalovirus
B. adenocarcinoma
Eisenberg, third edition p. 85
Which of the following advanced imaging modalities can be used to specifically demonstrate Barrett’s esophagus?
- MRI
- ultrasound
- CT
- radionuclide imaging
D. radionuclide imaging
Eisenberg, third edition p. 52
The most common infectious disease of the esophagus is:
- herpes
- cytomegalovirus
- candidiasis
- tuberculosis
C. candidiasis
Eisenberg, third edition p. 53
Recall phenomenon, repeated episodes of esophagitis and ulceration, is associated with:
- candidiasis
- postsclerotherapy
- caustic esophagitis
- chemotherapy
D. chemotherapy
Eisenberg, third edition p. 64
Single or multiple deep ulcers of the esophagus associated with sinus tracts and fistula formation within the wall of the esophagus and extending to the mediastinum are common are characteristic of:
- tuberculous esophagitis
- herpes esophagitis
- cytomegalovirus esophagitis
- candida esophagitis
A. tuberculous esophagitis
Eisenberg, third edition p. 59
“Downhill” esophageal varices are produced when venous blood from the head and neck
cannot reach the heart because of an obstruction of the _________?
- subclavian artery
- superior vena cava
- common carotid artery
- brachiocephalic trunk
B. superior vena cava
Eisenberg, third edition p. 125
What is the most common non-aortic vascular lesion producing an impression on the barium-filled thoracic esophagus?
- persistent truncus arteriosus
- aberrant left pulmonary artery
- aberrant right pulmonary artery
- anomalous pulmonary venous return
C. aberrant right pulmonary artery
Eisenberg, third edition p. 35
In patients with a hiatal hernia, a bolus of swallowed barium usually hesitates briefly at the lower end of the esophagus before filling a somewhat flared portion of the esophagus
(vestibule) just proximal to the stomach. This site of hesitation represents the uppermost
portion of an area of high resting pressure known as the:
- A ring
- B ring
- angle of His
- phrenic ampulla
A. A ring
Eisenberg, third edition p. 165
The lower esophageal ring which indicates the transition zone between esophageal and gastric
mucosa is known as:
- B ring
- cardioesophageal ring
- Oddi ring
- Schatzki’s ring
D. Schatzki’s ring
Eisenberg, third edition p. 164
Failure of sphincter relaxation is defined radiographically as barium retention above the lower esophageal sphincter for longer than:
- 0.5 seconds
- 1.5 seconds
- 2.5 seconds
- 3.5 seconds
C. 2.5 seconds
Eisenberg, third edition p. 11
A barium swallow demonstrating a normal stripping peristaltic wave that clears the upper esophagus but stops at about the level of the aortic arch is characteristic of which disease process?
- epidermolysis bullosa
- scleroderma
- achalasia
- feline esophagus
B. Scleroderma
Eisenberg, third edition p. 8
Destruction of the myenteric plexuses is due to an infection that develops from the bite of an infected reduviid bug, creating an achalasia pattern in the distal esophagus. This is characteristic of:
- epidermolysis bullosa
- Riley-Day syndrome
- Cowden’s disease
- Chagas disease
D. Chagas disease
Eisenberg, third edition p. 15
Retrocardiac calcification in a retrocardiac esophageal mass is diagnostic of:
- rhabdomyoma
- adenomatous polyp
- leiomyoma
- squamous papilloma
C. leiomyoma
Eisenberg, third edition p. 99
Which of the following is NOT a risk factor/etiologic factor in the development of carcinoma of the esophagus?
- smoking
- consumption of hot tea
- excessive alcohol intake
- consumption of spicy/hot foods
D. consumption of spicy/hot foods
Eisenberg, third edition p. 75
Which of the following diseases is associated with a disturbance in iron metabolism, predominantly in middle-aged women?
- Plummer-Vinson syndrome
- Barrett’s esophagus
- Epidermolysis bullosa
- Chagas disease
A. Plummer-Vinson syndrome
Eisenberg, third edition p. 72
The oral administration of tartaric acid and sodium bicarbonate to produce carbon dioxide that distends the esophagus may be used as an intervention technique in association with:
- impacted foreign body
- esophageal varices
- verrucous carcinoma
- reflux esophagitis
A. impacted foreign body
Eisenberg, third edition p. 111
In patients with severe vomiting, whether from dietary or alcoholic indiscretion or from any other cause, the sudden development of severe epigastric pain, with radiographic evidence of pneumomediastinum, or cervical emphysema, is suggestive of:
- rupture of a mid-esophageal traction diverticula
- Mallory-Weiss syndrome
- Boerhaave’s syndrome
- intramural abscess
C. Boerhaave’s syndrome
Eisenberg, third edition p.140
Mallory-Weiss syndrome usually occurs in which patient group?
- pregnant women
- obese middle-aged men and women
- newborns with congenital achalasia
- men over the age of 50 with a history of alcohol excess
D. men over the age of 50 with a history of alcohol excess
Eisenberg, third edition p. 141
Corrosive esophagitis is most commonly due to which of the following substances?
- sulfate
- lye
- nitrate
- hydrochloric acid
B. lye
Eisenberg, third edition p. 63
Amyloidosis, when found in the esophagus, produces what radiographic appearance?
- dilated esophagus with decreased peristalsis
- failure of relaxation of the lower esophageal sphincter
- repetitive nonperistaltic tertiary contractions
- superficial erosions that appear as streaks or dots of barium superimposed on the flat mucosa of the distal esophagus
A. dilated esophagus with decreased peristalsis
Eisenberg, third edition p. 11
Which of the following represents a neuromuscular cause of dysphagia in an adult?
- pharyngeal pouch
- scleroderma
- monilia
- Plummer-Vinson web
B. scleroderma
Chapman, 3rd p. 207
Which of the following types of diverticuli are found in the lower third of the esophagus?
- Traction diverticuli
- Epiphrenic diverticuli
- Zenker’s diverticuli
- Intramural diverticuli
B. Epiphrenic diverticuli
Chapman, 3rd p. 209
Which of the following conditions produces smooth esophageal strictures?
- radiotherapy
- leiomyosarcoma
- corrosive ingestion
- fundoplication
C. Corrosive ingestion
Chapman, 3rd p. 212
Which of the following syndromes is described as cervicoesophageal webs associated with iron-deficiency anemia and pharyngeal or esophageal carcinoma?
- Alport’s Syndrome
- Zenker’s
- Patterson-Kelly Syndrome
- Pharyngeal Carcinomatosis Syndrome (PCS)
C. Patterson-Kelly Syndrome
Paul and Juhl’s, Essentials of Radiological Imaging, 7th ed., Lippincott, 1998, p 554.
The compression of the superior vena cava may lead to which abnormality in the esophagus?
- Presbyesophagus
- Achalasia
- Downhill varices
- Uphill varices
C. Downhill varices
P.&J.
The expected radiographic finding associated with Plummer-Vinson syndrome is…
- Traction diverticula in the esophagus adjacent to the pulmonary hilar region
- Epiphrenic diverticula
- Anterior esophageal webs
- “Corkscrew” esophagus
C. Anterior esophageal webs
P.&J.
Zenker’s diverticulum can be found where?
- Superior-posterior esophagus
- Superior-anterior esophagus
- Mesenteric side of ileum
- Anti-mesenteric side of ileum
A. superior-posterior esophagus
P.&J.
An upper gastrointestinal examination with contrast reveals a filling defect of the esophagus with sharply demarcated edges (a sharp angle where the defect joins the esophageal wall). This is most consistent with…
- Leiomyoma
- Carcinoma
- Presbyesophagus
- Lye stricture
B. Carcinoma
P.&J.
The radiographic signs of obstruction of the esophagus at the level of the diaphragm, moderate dilatation of the esophagus and the presence of an air-fluid level are consistent with…
- Achalasia
- Chalasia
- Esophageal varices
- Esophageal strictures
A. Achalasia
P.&J.
The most common constituent of gallstones is…
- Calcium salts
- Bile pigments
- Cholesterol
- Calcium carbonate
C. Cholesterol
P.&J.
The most common cause for a non-functioning gallbladder is…
- Acute cholecystitis
- Chronic cholecystitis secondary to cholelithiasis
- Cholecystokinia deficiency
- Choledocal cyst
B. Chronic cholecystitis secondary to cholelithiasis
P.&J.
Most common cause of acute cholecystitis is obstruction from gallstones.
A. True
B. False
A. True
b+h 3rd pg 777
Which is not a risk factor for acalculous cholecystitis?
- over-consumption of fatty foods
- lack of oral intake
- post-burn
- post-trauma
A. over-consumption of fatty foods
b+h 3rd pg 778
acalculous disease is associated with biliary stasis
Which of the following is not a complication of acute cholecystitis?
- gangrenous cholecystitis
- gallbladder perforation
- emphysematous cholecystitis
- sludge
- mirizzi syndrome
D. sludge
b+h 3rd pg 778
Which of the following is not associated with chronic cholecystitis?
- thickened gallbladder wall
- porcelain gallbladder
- xanthogranulomatous cholecystitis
- perforation of the gallbladder
D. perforation of the gallbladder
b+h 3rd pg 778-9
Which is not true concerning adenomyomatosis in the gallbladder?
- most frequent benign condition affecting the gallbladder
- forms characteristic Rokitansky-Aschoff sinuses
- has no malignant potential
- rarely has co-existing gallstones
D. rarely has co-existing gallstones
b+h 3rd pg 780
gallstones commonly co-exist
Which is not true concerning gallbladder carcinoma?
- cell type is squamous cell
- gallstones present in 70-80% of cases
- most common in women over 60 yoa
- porcelain gallbladder is a risk factor
A. cell type is squamous cell
b+h 3rd pg 780
it is an adenocarcinoma
What percentage of a patient’s with gallbladder carcinoma present with stones?
- 20%
- 40%
- 60%
- 80%
D. 80%
Handbook of GI and GU Radiology p. 126
Sclerosing cholangitis is a rare inflammatory condition of the bile ducts in which stenosis occurs for no known reason. Which of the following conditions is associated with sclerosing cholangitis?
- Crohn’s disease
- Primary biliary cirrhosis
- Wilson’s disease
- Hepatitis
A. Crohn’s disease
Handbook of GI and GU Radiology p. 127
The normal gallbladder length should not exceed?
- 2cm
- 6cm
- 12cm
- 20cm
C. 12 cm
Handbook of GI and GU Radiology p. 128
An older woman presents to your office with a history of right upper quadrant pain and constipation. You take a KUB and discover gas in the biliary tree. What is the most likely diagnosis?
- Gallstone ileus
- Appendicitis
- Kidney stones
- Behcet’s syndrome
A. Gallstone ileus
Eisenberg 3rd ed. p.517
The gallbladder is frequently folded on itself, but the position of the fold may not be fixed. When the gallbladder fundus folds on itself, it produces an appearance similar to a:
- Hartmann’s pouch
- junctional fold
- quadrate lobe
- Phrygian cap
D. Phrygian Cap
Taveras, Chpt 66, pg. 1
What percentage of gallstones are calcified and readily identifiable on plain films?
- 5-10%
- 10-15%
- 20-25%
- 90-95%
B. 10-15%
P&J pg. 522
What is the most common positional anomaly of the gallbladder?
- left-sided gallbladder
- intrapelvic gallbladder
- intrahepatic gallbladder
- double gallbladder
C. intrahepatic gallbladder
Taveras, Chpt 66, pg. 1
Patients with an uncommon congenital focal dilation of the extrahepatic bile duct, are at risk of rupture and biliary and duodenal obstruction, and are at increased risk of developing:
- Caroli’s disease
- biliary ductal atresia
- primary sclerosing cholangitis
- cholangiocarcinoma
D. cholangiocarcinoma
P&J pg. 532
Which of the following statements regarding gallbladder ultrasonography is true?
- six hours of fasting is required
- jaundice may interfere with the accuracy of the examination
- oral cholecystography can detect smaller stones than ultrasound
- GB ultrasonography is the preferred follow-up imaging modality of choice for the detection of biliary dilatation
A. six hours of fasting is required
P&J pg. 524
What is the gallbladder imaging procedure which allows the operator (radiographic technician) to institute biliary drainage if necessary?
- percutaneous transhepatic cholangiography
- oral cholecystography
- cholescintigraphy
- T-tube cholangiography
A. percutaneous transhepatic cholangiography
P&J pg. 524
What is the most common cause of acute cholecystitis?
- post-surgical inflammation
- patients receiving hyperalimentation
- trauma
- calculus
D. calculus
P&J pg. 527
A strawberry gallbladder is associated with:
- adenomyomatosis
- cholesterolosis
- annular pancreas
- hydrops
B. cholesterolosis
P&J pg.. 536
Prophylactic cholecystectomy is generally performed in patients with:
- acute cholecystitis
- choledochocele
- emphysematous cholecystitis
- porcelain gallbladder
D. porcelain gallbladder
Taveras, Chpt. 67, pg. 1
Milk of calcium of bile is usually composed of:
- calcium carbonate
- calcium magnesium
- calcium phosphate
- ammonium
A. calcium carbonate
Taveras, Chpt 67, pg. 1
An overgrowth of gallbladder mucosa with development of mural thickening and intramural diverticuli is known as:
- hyperplastic cholecystoses
- elastosis neuromatosis
- adenomyomatosis
- primary sclerosing cholangitis
C. adenomyomatosis
P&J pg. 536
Radiographic findings on a KUB including air in the biliary tree, dilated loops of the small bowel, and calcification in an unusual position within the abdomen, usually in the right lower quadrant are suggestive of:
- emphysematous cholecystitis
- gallstone ileus
- pneumobilia
- Mirizzi syndrome
B. gallstone ileus
Taveras, Chpt. 67, pg. 3
Diffuse inflammatory fibrosis of the biliary tree may result in obliteration of the peripheral ducts, creating a “pruned tree” appearance. This is associated with:
- primary sclerosing cholangitis
- choledochal cysts
- acute cholecystitis
- primary biliary cirrhosis
A. primary sclerosing cholangitis
Taveras, Chpt. 68A, pg. 2
Achalasia is due to a deficiency of ganglion cells in the _________ plexus.
a. Meissner
b. Auerbach
c. celiac
d. cervical
b. Auerbach
Achalasia can resemble carcinoma of the gastroesophageal junction but carcinoma involves a _________ segment and causes more __________ tapering of the distal segment.
a. shorter, irregular
b. shorter, regular
c. longer, irregular
d. longer, regular
c. longer, irregular
A _________ diverticulum is in the posterior midline of the hypopharynx at Killian’s dehiscence and __________ likely to be symptomatic.
a. Zenker, is not
b. Zenker, is
c. Killian-Jamieson, is not
d. Killian-Jamieson, is
b. Zenker, is
Which is the most common type of carcinoma of the esophagus?
a. Adenocarcinoma
b. Squamous cell
c. Small cell
d. Humongous cell
b. Squamous cell
What is the most common benign neoplasm of the esophagus?
a. Leiomyoma
b. Polyp
c. Pharyngeal retention cyst
d. Esophageal duplication cyst
a. Leiomyoma
Where is the most common location for the tears associated with Boerhaave Syndrome?
a. near the left crus of the diaphragm
b. near the right crus of the diaphragm
c. at the midpoint of the esophagus
d. at the upper esophageal sphincter
a. near the left crus of the diaphragm
Which type of esophageal perforation involves only the mucosal layer?
a. Boerhaave
b. Zenker
c. Mallory-Weiss
d. Killian-Jamieson
c. Mallory-Weiss
What is the most common cause for esophageal perforation?
a. Boerhaave syndrome
b. Esophageal instrumentation
c. Adenocarcinoma
d. Mallory-Weiss tears
b. Esophageal instrumentation
T or F: H. pylori causes 95% of duodenal ulcers.
TRUE
Rate the incidence of gastrointestinal malignancy based on location:
a. stomach > pancreas > colon
b. pancreas > stomach > colon
c. colon > stomach > pancreas
d. colon > pancreas > stomach
d. colon > pancreas > stomach
T or F: Breast cancer metastasis is the most common cause of linitis plastica.
TRUE
Which of the following is not a growth pattern associated with gastric carcinoma?
a. Polypoid mass
b. Ulcerative mass
c. Hemostatic tumor
d. Infiltrating tumor
c. Hemostatic tumor
Why does gastrointestinal lymphoma have a better prognosis than gastrointestinal carcinoma?
a. Lymphoma grows more slowly
b. Lymphoma responds better to chemotherapy
c. Lymphoma remains confined to the bowel wall
d. Lymphoma is more likely in younger, healthier people who are more likely to recover
c. Lymphoma remains confined to the bowel wall
Which of the following is NOT used to gauge the malignancy of a gastrointestinal stromal tumor?
a. Size of tumor
b. Gross appearance
c. Behavior of tumor
d. Age of patient at presentation
d. Age of patient at presentation
Which portion of the duodenum is most commonly constricted by an annular pancreas?
a. Descending
b. Transverse
c. Ascending
d. All portions are equally likely to be constricted
a. Descending
Which of the following signs and symptoms is NOT associated with Ménétrier disease?
a. Massive gastric folds
b. Self-limiting in adults
c. Excessive amounts of transforming growth factor α
d. Protein-losing gastropathy
b. Self-limiting in adults
Flattened or absent villi and a decrease in the number of intestinal absorptive cells are characteristics of which disease?
a. Ulcerative colitis
b. Celiac disease
c. Ménétrier disease
d. Peutz-Jegher syndrome
b. Celiac disease
Behçet disease resembles what other disease when presenting at the ileocecal junction?
a. Ulcerative colitis
b. Celiac disease
c. Ménétrier disease
d. Peutz-Jegher syndrome
b. Celiac disease
T or F: A Morgagni hernia is the most common diaphragmatic hernia.
FALSE
A defect in the hemidiaphragm at the site of the embryonic pleuroperitoneal canal is called a ________ hernia.
a. Bochdalek
b. Morgagni
c. ventral
d. epigastric
a. Bochdalek
Familial hamartomatous polyps with melanin freckles are symptoms of which disease?
a. Cowden disease
b. Cronkhite-Canada syndrome
c. Caroli disease
d. Peutz-Jeghers syndrome
d. Peutz-Jeghers syndrome
Which of the following is NOT associated with Caroli disease?
a. Saccular ectasia of the intrahepatic bile duct
b. Medullary sponge kidney
c. Biliary obstruction
d. Autosomal recessive polycystic kidney disease
c. Biliary obstruction
The Todani classification is applied to which type of cysts?
a. Choledocal
b. Duplication
c. Retention
d. Hydatid
a. Choledocal
Occlusion of hepatic veins from hepatic venous or inferior vena cava obstruction is characteristic of which disease/syndrome?
a. Budd-Chiari
b. Caroli
c. Cowden
d. Cronkhite-Canada
a. Budd-Chiari
T or F: Adenocarcinoma is the most common primary malignancy of the liver.
FALSE
Wall echo shadow sign is associated with which of the following?
- Appendicolith
- Cholelithiasis
- Entericolith
- Nephrolithiasis
- Uterine fibroid
b. Cholelithiasis
The Hurst phenomenon is associated with which of the following?
- Achalasia
- Candida esophagitis
- Diffuse esophageal spasm
- Esophageal varices
- Gastric adenocarcinoma
a. Achalasia
Which of the following lies in the range of causing self limiting radiation esophagitis?
- 100 rads
- 1,000 rads
- 3,500 rads
- 6,000 rads
- 10,000 rads
c. 3,500 rads
Which of the following represents the 3rd most common manifestation of involvement of scleroderma?
- Anorectal
- Esophagus
- Raynaud phenomenon
- Skin
- Stomach
b. Esophagus
Over which age does tylosis leads to squamous cell carcinoma of the esophagus in 95% of those afflicted?
- 15 years
- 25 years
- 35 years
- 55 years
- 70 years
e. 70 years
Which of the following could represent a cause of Curling ulcers of the stomach?
- Alcoholism
- Helicobacter pylori
- NSAID consumption
- Severe burns
- Spirochete infection
d. Severe burns
Which of the following blood types are most predisposed to developing duodenal ulcers?
- A+
- AB
- B-
- B+
- O
e. O
