Disorders of gallbladder and bile ducts

Question 1

Which one is the most important factor in gall clearence?
A) gastrin
B) nitrogen monoxide
C) secretin
D) cholecystokinin
E) VIP

Answer 1

D) cholecystokinin

Question 2

Which one is the most frequent gallstone?
A) Cholesterol stone
B) Bilirubin stone
C) Mixed stone
D) Oxalate stone

Answer 2

A) Cholesterol stone

Question 3

Which symptom is not characteristic to disorders of biliary excretion?
A) abdominal distension
B) ”fullness” feeling
C) severe steatorrhoea
D) abdominal discomfort
E) pain under the right ribs

Answer 3

C) severe steatorrhoea

Question 4

How often is the outlet of the ductus choledochus and the ductus pancreaticus joint (Ampulla of Vater)?
A) 10%
B) 30%
C) 50%
D) 70%
E) 90%

Answer 4

E) 90%

Question 5

Which of the following agents facilitate biliary excretion?
1) CCK
2) secretin
3) bile salts
4) adrenalin

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 5

A) 1st, 2nd and 3rd answers are correct

Question 6

What is the procedure to choose in case of incidentally discovered gallstones not causing any symptomes?
1) surgical removal of the gallbladder
2) lithotripsy performed with ultrasound
3) starting a lasting gallstone solubilizer medication
4) informing the patient of the gallstones and personalized therapeutic consideration

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 6

D) only 4th answer is correct

Question 7

Which of the following does decrease the spasm of the Oddi sphincter?
1) nitrates
2) chocolate
3) cholecystokinin
4) morphine

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 7

A) 1st, 2nd and 3rd answers are correct

Question 8

What are the indications of endoscopic sphincterotomy?
1) choledocholithiasis
2) Oddi-sphincter-dyskinesis
3) acute recidive gallbladder attack resulting in acute pancreatitis
4) carcinoma of the pancreatic head

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 8

A) 1st, 2nd and 3rd answers are correct

Question 9

Which of the following procedures are useful for functional examination of the gallbladder?
1) liver scintigraphy
2) MRCP (magnetic resonance cholangiopancreatography)
3) intravenous urography
4) cholescintigraphy

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 9

C) 2nd and 4th answers are correct

Question 10

Which enzyme of the bile contributes to fat digestion?
1) lipase
2) cholic acid
3) colipase
4) neither of the aforementioned

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 10

D) only 4th answer is correct

Question 11

What is the Courvoisier-sign?
1) pain under the right ribs + jaundice + fever
2) jaundice + melaena + epigastric pain
3) fever + jaundice + tactile resistance in the upper abdomen
4) tactile, not painful enlarged gallbladder

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 11

D) only 4th answer is correct

Question 12

Which of the following diseases can cause direct hyperbilirubinaemia?
1) Gilbert’s syndrome
2) Rotor syndrome
3) haemolysis
4) choledocholithiasis

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 12

C) 2nd and 4th answers are correct

Question 13

What is the most important differentiating laboratory parameter in cases of obstructive jaundice?
1) elevated direct bilirubin
2) elevated total bilirubin
3) elevated urinary UBG
4) no UBG in the urine

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 13

D) only 4th answer is correct

Question 14

Which statements are true regarding biliary functions and blood cholesterol levels?
1) Elevated biliary functions elevate blood cholesterol levels.
2) Elevated biliary functions decrease blood cholesterol levels.
3) Elevated biliary functions elevate LDL levels.
4) Bile is the only elimination route for cholesterol from the body.

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 14

C) 2nd and 4th answers are correct

Question 15

Which of the following may be the complication of gallstones?
1) obstructive jaundice
2) acute pancreatitis
3) cholecystitis
4) chronic pancreatitis

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 15

E) all of the answers are correct

Question 16

Solubizing the gallstone which is smaller than 2 cm and has been formed during pregancy is advised later, because pregnancy is only a temporary state predisposing to gallstone formation.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer 16

A) both the statement and the explanation are true and a causal relationship exists between them;

Question 17

All gallstones should be surgically removed, because gallstone is formed only in permanently functionally damaged gallbladders.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer 17

E) both the statement and the explanation are false

Question 18

Sudden dieteing does not predispose to gallstone formation, because environment in non-functioning gallbladders favors gallstone formation.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer 18

D) the statement is false, but the explanation itself is true

Question 19

Laparoscopic cholecystectomy is a lower load for the patient compared to open cholecystectomy, because the abdomen is not opened in a large surface.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer 19

A) both the statement and the explanation are true and a causal relationship exists between them;

Question 20

Abdominal ultrasound examination can detect gallbladder carcinoma with great security, therefore gallbladdder carcinoma is usually detected at early stage.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer 20

E) both the statement and the explanation are false

Question 21

Gallstones are generated in the gallbladder, because in the gallbladder the concentration of the bile is at least fivefold.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer 21

A) both the statement and the explanation are true and a causal relationship exists between them;

Question 22

Treatment of chronic abdominal complaints occurring after cholecystectomy is easy, because in these cases with the introduction of antacid treatment most symptoms can be ceased.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer 22

E) both the statement and the explanation are false

Question 23

Klatskin tumour can be easily removed surgically, because the tumour is located in the porta hepatis.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer 23

D) the statement is false, but the explanation itself is true

Question 24

The common bile duct (ductus choledochus) usually leads to the duodenum through the minor papilla, because the duct of Wirsung leads to the duodenum through the ampulla of Vater.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer 24

D) the statement is false, but the explanation itself is true

Question 25

Ultrasound scan detects bile duct stones with great certainty, because ultrasound is absolute reliable in the detection of gallbladder stones as well.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer 25

D) the statement is false, but the explanation itself is true

Question 26

The surgical solution of bile duct stenoses is advised, when the intervention with ERCP is unsuccessful, because surgical intervention is cheaper than stent exchanges.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer 26

C) the statement is true, but the explanation is false;

Question 27

Prophylactic antibiotic therapy in obstructive jaundice decreases the complication rate of ERCP, because the assurance of free bile flow is of secondary importance.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer 27

C) the statement is true, but the explanation is false;

Question 28

In case of gallstones the first choice of treatment is always medical stone dissolution, because it is cheap and only 10% of gallstones recur within two years.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer 28

E) both the statement and the explanation are false

Question 29

Gallstone production is common in small bowel diseases, because in these cases the reabsorption of bile acids that keep the bile in solution is damaged.
A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

Answer 29

A) both the statement and the explanation are true and a causal relationship exists between them;

Question 30

What is the first choice of examination?
A 45-year-old woman with known bile stones complains of a cramping, severe abdominal pain under the right ribs irradiating in the scapulae, beginning about 30 minutes after eating and associated by nausea. During physical examination she indicates a strong pain on pressure under the right ribs, and fluctuating resistance can be felt here.
A) abdominal CT
B) stomach X-ray
C) gastroscopy
D) abdominal US
E) chest X-ray

Answer 30

D) abdominal US

Question 31

What labor test helps setting the correct diagnosis?
A 45-year-old woman with known bile stones complains of a cramping, severe abdominal pain under the right ribs irradiating in the scapulae, beginning about 30 minutes after eating and associated by nausea. During physical examination she indicates a strong pain on pressure under the right ribs, and fluctuating resistance can be felt here.
1) white blood cell count
2) serum-amylase
3) total urine
4) direct bilirubin

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 31

E) all of the answers are correct

Question 32

What is the most probable diagnosis?
A 45-year-old woman with known bile stones complains of a cramping, severe abdominal pain under the right ribs irradiating in the scapulae, beginning about 30 minutes after eating and associated by nausea. During physical examination she indicates a strong pain on pressure under the right ribs, and fluctuating resistance can be felt here.
A) acute pancreatitis
B) gallstone ileus
C) gastric perforation
D) hydrops vesicae felleae
E) choledocholithiasis

Answer 32

D) hydrops vesicae felleae

Question 33

What therapuetic interventions are considered?
A 45-year-old woman with known bile stones complains of a cramping, severe abdominal pain under the right ribs irradiating in the scapulae, beginning about 30 minutes after eating and associated by nausea. During physical examination she indicates a strong pain on pressure under the right ribs, and fluctuating resistance can be felt here.
1) inserting a central venous catheter and administering nitrates
2) laparoscopic cholecystectomy
3) endoscopic sphincterotomy and stone extraction
4) complete fasting, conservative medical treatment

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 33

C) 2nd and 4th answers are correct

Question 34

What is the next examination of choice?
A 78-year-old man is admitted to the hospital because of significant weight loss and jaundice. Abdominal US confirms a gallbladder without stone and dilated intrahepatic bile ducts, the extrahepatic bile ducts are not wider.
A) iv. cholescintigraphy
B) abdominal CT
C) ERCP
D) percutaneous transhepatic drainage

Answer 34

C) ERCP

Question 35

Which laboratory results help in setting the diagnosis?
A 78-year-old man is admitted to the hospital because of significant weight loss and jaundice. Abdominal US confirms a gallbladder without stone and dilated intrahepatic bile ducts, the extrahepatic bile ducts are not wider.
1) normal CRP level
2) elevated erythrocyte sedimentation rate
3) high LDH level
4) elevated CEA level

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 35

C) 2nd and 4th answers are correct

Question 36

What is the most probable diagnosis?
A 78-year-old man is admitted to the hospital because of significant weight loss and jaundice. Abdominal US confirms a gallbladder without stone and dilated intrahepatic bile ducts, the extrahepatic bile ducts are not wider.
A) acute cholecystitis
B) acute hepatitis
C) primary biliary cirrhosis
D) bile duct tumour (Klatskin)
E) pancreas head carcinoma

Answer 36

D) bile duct tumour (Klatskin)

Question 37

What is the treatment of choice?
A 78-year-old man is admitted to the hospital because of significant weight loss and jaundice. Abdominal US confirms a gallbladder without stone and dilated intrahepatic bile ducts, the extrahepatic bile ducts are not wider.
A) bypass surgery
B) ERCP, stent implantation
C) duodenal tube
D) treatment with ursodeoxycholic acid
E) bedrest, supportive treatment

Answer 37

B) ERCP, stent implantation

Question 38

Typical symptoms of Caroli syndrome:
1) recurring cholangitis
2) haematuria
3) shaking chills, fever
4) peptic duodenal ulcer

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 38

B) 1st and 3rd answers are correct

Question 39

Morphological characteristics of Caroli syndrome:
1) fusiform dilation of intrahepatic bile ducts
2) crooked cystic duct
3) bile duct stenosis
4) shortened common bile duct

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 39

B) 1st and 3rd answers are correct

Question 40

Criterion of early cholecystectomy in case of gallstones:
1) jaundice
2) previous abdominal operation
3) cholangitis not responding to antibiotics
4) within 24-72 hours after the formation of symptoms

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 40

D) only 4th answer is correct

Question 41

Criterion of the solution of gallstones with bile acids:
1) permeable cystic duct
2) calcareous gallbladder
3) well contracting gallbladder
4) age above 50 years

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 41

B) 1st and 3rd answers are correct

Question 42

Characteristics of gallbladder polyps:
1) 95 percent are benign
2) can be detected with ultrasound
3) adenomas larger than 10 mm are precancerous
4) inflamed polyps are common

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 42

A) 1st, 2nd and 3rd answers are correct

Question 43

Characteristics of Mirizzi’s syndrome:
1) obstructive icterus
2) normal bilirubin level
3) dilated hepatic duct
4) diarrhoea

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 43

B) 1st and 3rd answers are correct

Question 44

Possible cause of gallbladder hypokinesia:
1) diabetes
2) extended starvation
3) pregnancy
4) steroid treatment

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 44

A) 1st, 2nd and 3rd answers are correct

Question 45

It can be typical symptom of tumour of the ampulla of Vater:
1) jaundice
2) fever
3) pruritus
4) diarrhoea

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 45

B) 1st and 3rd answers are correct

Question 46

Possible symptom of postcholecystectomy syndrome:
1) constipation
2) weight loss
3) nausea
4) diarrhoea

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 46

D) only 4th answer is correct

Question 47

Possible cause of postcholecystectomy syndrome:
1) cystic duct remnant syndrome
2) bile duct stenosis
3) remaining bile duct stone
4) gallstone ileus

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 47

A) 1st, 2nd and 3rd answers are correct

Question 48

Characteristics of cholelithiasis:
1) can be detected in 10 percent of the population
2) more common in women than in men
3) its incidence increases with age
4) its prevalence does not change with age

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 48

A) 1st, 2nd and 3rd answers are correct

Question 49

Characteristics of juxtapapillary diverticulum:
1) can be cause of chronic liver disease
2) endoscopic papillotomy is contraindicated
3) is often associated with bile duct malformations
4) raises the risk of bile duct stones

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 49

D) only 4th answer is correct

Question 50

The most common location of obstruction in gallstone ileus:
1) hepatic flexure
2) colonic diverticulum
3) duodenal diverticulum
4) ileocecal valve

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 50

D) only 4th answer is correct

Question 51

Predisposing factors of acute acalculous cholecystitis, except:
1) prolonged starvation
2) immobility
3) hemodynamic instability associated with severe abdominal diseases
4) nonalcoholic steatohepatitis

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 51

D) only 4th answer is correct

Question 52

It may be the complication of choledocholithiasis:
1) chronic cholangitis
2) biliary pancreatitis
3) secondary biliary cirrhosis
4) liver cyst

A) 1st, 2nd and 3rd answers are correct
B) 1st and 3rd answers are correct
C) 2nd and 4th answers are correct
D) only 4th answer is correct
E) all of the answers are correct

Answer 52

A) 1st, 2nd and 3rd answers are correct