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Shahid > GIT- Warm Up > Flashcards

GIT- Warm Up Flashcards

1
Q

@#e 1. The following statements regarding acute pancreatitis are true: (T/F)

a) Mumps is a recognized cause

b) Pancreatic oedema is a late sign

c) Pancreatic necrosis demonstrated on CT is associated with a mortality of 5-10%

d) Right-sided pleural effusion is seen in 5%

e) Haemorrhagic pancreatitis is diagnosed by the presence of hypodense areas of 5-20 Hounsfield units on CT

A

1.

a) True - alcohol and gallstones are commonest

b) False - this is the earliest sign

c) False - there is a mortality of more than 20%

d) False-left-sided

e) False - hyperdense areas of 50-70 Hounsfield units

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2
Q

@# Regarding hepatocellular carcinoma: (T/F)

a) It is the commonest primary visceral malignancy in the world

b) Haemochromatosis is a recognized cause

c) Elevated alpha-fetoprotein is found in 50-60% of cases

d) Has a higher incidence in macronodular than micronodular cirrhosis

e) On MR, hepatoma has a well defined, hypointense capsule on T1 weighted images

A

a) True

b) True - other causes are cirrhosis, hepatitis, alpha-1 antitrypsin deficiency, Wilson’s disease, aflatoxin, thorotrast

c) False-90%

d) True

e) False - increased signal intensity on a T2 weighted image. Peripheral gadolinium enhancement is seen in about 20%

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3
Q

@# 3. The following are true of positron emission tomography (PET): (T/F)

a) Noise is higher than in single-photon emission computed tomography

b) Detectors are made of bismuth germinate

c) Resolution is better than in SPECT

d) The effective dose is much higher than in routine gamma imaging

e) It is reliant on the release of gamma rays

A

3.

a) False - lower

b) True

c) True

d) False

e) False-positive beta particle emission

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4
Q
  1. Regarding MRI of the liver: (T/F)

a) Fast spin echo involves a series of 180 degree refocusing pulses after the initial 90 degree pulse

b) Hepatocellular carcinoma is best demonstrated 20-30 seconds after contrast injection on a Tl weighted gadolinium-enhanced image

c) Haemangiomas are of uniform low signal on T1 weighted MRI

d) Dynamic imaging of haemangiomas shows a dense peripheral nodular blush during the arterial phase of liver perfusion

e) Hepatocellular carcinoma is usually hypointense on T2 weighted MRI

A

4.
a) True

b) True

c) True

d) True - though small haemangiomas have a uniform immediate enhancement pattern of the whole lesion

e) False - increased signal intensity on T2 weighted images and reduced signal on TI

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5
Q

@#e 5. The following statements regarding pancreatic carcinoma are true: (T/F)

a) 60-70% of pancreatic carcinomas arise in the tail

b) They are usually hypovascular

c) Calcification is common

d) Contiguous organ invasion is rare

e) On ultrasound appears as a hyperechoic pancreatic mass

A

5.
a) False - 60-70% in the head, 30% body and 10% in the tail

b) True

c) False - about 2%

d) False - 40% invade oesophagus, stomach, duodenum

e) False - hypoechoic

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6
Q
  1. Regarding pancreatic islet cell tumours: (T/F)

a) Glucagonoma is the commonest functioning islet cell tumour

b) Insulinoma is found predominantly in the pancreatic body and tail

c) Glucagonoma is a hypervascular tumour

d) Glucagonoma undergoes malignant transformation in 5-10%

e) Multiple insulinomas are associated with MEN Type 1

A

6.
a) False - insulinoma

b) False - glucagonoma. Insulinoma has no predilection for any part

c) True - 90% of glucagonomas are hypervascular. 66% of insulinomas

d) False - insulinoma. 80% glucagonomas undergo malignant transformation. 50% have liver metastases at diagnosis

e) True

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7
Q

@#e 7. Regarding porcelain gallbladder: (T/F)

a) It is often symptomless

b) It is rarely associated with gallstones

c) Oral cholecystogram shows a non-functioning gallbladder

d) 60-70% develop carcinoma of the gallbladder

e) Acute pancreatitis is a recognized cause

A

7.

a) True

b) False - 90%

c) True

d) False 10-20%

e) False

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8
Q
  1. Regarding pancreatic cysts: (T/F)

a) 70-80% of pancreatic cysts are pseudocysts

b) 10% of patients with autosomal dominant polycystic kidney disease have associated pancreatic cysts

c) Pancreatic pseudocysts can occur in the posterior mediastinum

d) Serous cystadenoma is a common malignant tumour found in children

e) Persistent cysts exceeding 5 cm in diameter require drainage

A

8.

a) True -25% are true cysts, i.e retention/dermoid/malignant cysts

b) True - in von Hippel-Lindau syndrome pancreatic cysts are present in more than 50%

c) True - most commonly found in the lesser sac but can be found in the inguinal region and mediastinum

d) False - benign tumour of elderly women which has a characteristic sunburst calcified appearance with a central fibrotic scar

e) True- to prevent complications of rupture/infection/haemorrhage

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9
Q

@#e 9. The following statements regarding splenic lymphoma are true: (T/F)

a) The spleen is involved at presentation in 30-40% of patients with non-Hodgkin’s lymphoma

b) Focal splenic deposits are usually well defined, round lesions of increased brightness on ultrasound

c) When there is lymphomatous involvement of the spleen, splenomegaly is seen in 70-80%

d) Splenic lymphoma deposits commonly calcify

e) Lymph nodes are seen in the splenic hilum in 50% of patients with Hodgkin’s lymphoma

A

9.

a) True - slightly higher for Hodgkin’s lymphoma

b) False - reduced echogenicity

c) False -50%

d) True

e) False - uncommon

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10
Q

@# 10. The following are features of extrahepatic cholangiocarcinoma: (T/F)

a) It accounts for 10-15% of all cholangiocarcinomas

b) Is most commonly identified in children under 6 years old

c) Inflammatory bowel disease increases the risk by 2 times

d) Most commonly found in the cystic duct

e) Hypovascular on angiography

A

10.

a) False - extrahepatic is commoner accounting for 90%

b) False - 50-60-year-olds

c) False - 10 times increased risk. Other predisposing factors include sclerosing cholangitis, Caroli’s disease, thorotrast exposure, alpha-1 antitrypsin deficiency and autosomal
dominant polycystic kidney disease

d) False - most commonly involves the common bile duct

e) False - hypervascular tumour

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11
Q

@# 11. Features of the MEN II syndrome (Sipple’s syndrome) include: (T/F)

a) Insulinoma

b) Phaeochromocytoma

c) Hyperparathyroidism

d) Medullary carcinoma of the thyroid

e) Pituitary adenoma

A

11.

a) False

b) True

c) True

d) True

e) False

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12
Q
  1. Liver lesions which appear echogenic on ultrasound include: (T/F)

a) Lymphoma

b) Cervical cancer metastases

c) Colonic carcinoma metastases

d) Hepatoma

e) Treated breast cancer metastases

A

12.

a) False

b) False

c) True

d) True

e) True

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13
Q
  1. The following are causes of generalised increase in liver echogenicity on ultrasound: (T/F)

a) Fatty infiltration

b) Cirrhosis

c) Lymphoma

d) Chronic hepatitis

e) Vacuolar degeneration

A

13.

a) True

b) True

c) False

d) True

e) True

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14
Q

@#e 14. Regarding Budd-Chiari syndrome: (T/F)

a) It can be caused by obstruction of the suprahepatic IVC

b) On early CT images, the central liver enhances prominently and the peripheral liver weakly

c) The caudate lobe is markedly atrophic

d) On MRI images ‘comma-shaped’ intrahepatic collateral vessels are seen

f) A ‘spider’s web’ appearance at hepatic venography is characteristic

A

14.

a) True - this is primary obstruction. Secondary obstructions commoner and are due to thrombosis in hepatic veins

b) True - ‘flip-flop’ pattern. On late images the central liver has washed out and peripherally there is enhancement

c) False - caudate lobe is enlarged

d) True

e) True

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15
Q
  1. Features of portal hypertension include: (T/F)

a) Portal vein diameter of> 13 mm

b) Splenomegaly

c) Reduction in portal vein velocities to 7-12 cm/s

d) Schistosomiasis is a recognized cause

e) Loss of portal venous flow in expiration

A

15.

a) True

b) True

c) True

d) True

e) True

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16
Q
  1. Features of focal nodular hyperplasia (FNH) include: (T/F)

a) Hypovascular

b) Necrosis and haemorrhage are common

c) 80-90% of tumours are multiple

d) A strong association with oral contraceptive use

e) 50-70% show reduced activity on technetium sulphur colloid scanning

A

16.

a) False-hypervascular

b) False - rare in FNH but common in hepatic adenoma

c) False - solitary

d) False - no association. Hepatic adenoma is associated

e) False - 50-70% normal or increased activity

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17
Q
  1. Splenic hamartomas are: (T/F)

a) Usually associated with hamartomas in other locations

b) The most common primary splenic tumour

c) of reduced attenuation on unenhanced CT

d) of heterogenous increased signal intensity on T2 weighted MRI images

e) Associated with Turner’s syndrome

A

17.

a) True

b) False - rare non-neoplastic lesion

c) True

d) True

e) False - splenic haemangiomas are associated

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18
Q
  1. Features of hydatid disease of the liver include: (T/F)

a) Raised blood eosinophilia count

b) Left lobe is more commonly affected than the right lobe

c) Rarely calcifies

d) On ultrasound, appearances of a heterogenous mass with daughter cysts

e) Communication with right hepatic duct in 50-60%

A

18.

a) True

b) False - right lobe more than the left. Multiple in 20%

c) False - peripheral calcification in 20-30%. Eggshell calcification in the cyst wall is a rare appearance

d) True

e) True - left hepatic duct in 30%. Common hepatic duct in 10%

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19
Q
  1. Epidermoid cysts of the spleen: (T/F)

a) Are multiple in 80%

b) Are usually < 1 cm in size

c) Peripheral septations are extremely rare

d) Central calcification is seen in 70-80%

e) Are associated with autosomal dominant polycystic kidney disease

A

19.

a) False - solitary in 80%

b) False- usually 10 cm in size

c) False - found in 85%

d) False - calcification in the wall is seen in 10-20%

e) True

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20
Q
  1. The following statements are true: (T/F)

a) Hepatic veins have no valves

b) Ligamentum teres is the obliterated remnant of the umbilical artery

c) The portal vein is formed by the inferior mesenteric vein and splenic vein

d) Hepatic veins drain to the IVC without an extrahepatic course

e) In the Couinaud system - segment 2 and 4a are divided by the left hepatic vein

A

20.

a) True

b) False - left umbilical vein

c) False - superior mesenteric vein and splenic vein

d) True

e) True

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21
Q
  1. The following are normal post-liver transplant findings: (T/F)

a) Right pleural effusion

b) Fluid collection around the falciform ligament

c) Sub-hepatic haematoma

d) increase in the hepatic artery velocity to 300 cm/s

e) Periportal low attenuation collar on CT

A

21.

a) True

b) True

c) True

d) False - this is a sign of hepatic artery stenosis complicating liver transplant

e) True - periportal oedema seen in 20%

22
Q
  1. The following statements regarding hepatoblastoma are true: (T/F)

a) It is the commonest hepatic tumour in children under 3 years

b) There is an increased incidence in Beckwith-Wiedemann syndrome

c) It frequently metastasizes to the lung

d) It is associated with an elevated alpha fetoprotein

e) 20% are multifocal

A

22.

a) True

b) True

c) False

d) True

e) True

23
Q
  1. Thickened gastric folds are seen in: (T/F)

a) Eosinophilic gastroenteritis

b) Uncomplicated coeliac disease

c) Ménétrier’s disease

d) Systemic sclerosis

e) Crohn’s disease

A

23.

a) True

b) False

c) True

d) False

e) True

24
Q
  1. Target lesions in the stomach are seen in: (T/F)

a) Melanoma metastases

b) Ectopic pancreatic tissue

c) Radiation enteritis

d) Neurofibroma

e) Leiomyoma

A

a) True

b) True

c) False

d) True

e) True

25
Q
  1. Causes of widening of the retrorectal space include: (T/F)

a) Crohn’s disease

b) Radiotherapy

c) Pelvic lipomatosis

d) Enteric duplication cysts

e) Systemic sclerosis

A

25.

a) True

b) True

c) True

d) True

e) False

26
Q
  1. The following are gastrointestinal features of systemic sclerosis: (T/F)
    a) Strictures of the gastro-oesophageal junction
    b) Dilated small bowel
    c) Thickened small bowel mucosal folds
    d) Atonic colon
    e) Pseudosacculations on the mesenteric border in the colon
A

26.

a) False - the gastro-oesophageal junction is widely open with marked reflux

b) True

c) True

d) True

e) False - antimesenteric border. In the small bowel pseudodiverticula are found on the mesenteric side

27
Q

27.
The following statements concerning oesophageal carcinoma are true: (T/F)

a) 90% of cases are squamous cell carcinomas

b) Most commonly located in the upper third of the oesophagus

c) Plummer-Vinson syndrome is a recognized predisposing factor

d) Commonest appearance on double contrast barium swallow is of a large ulcer within a bulging mass

e) It is associated with ulcerative colitis

A

27.

a) True

b) False -20% in the upper third, 30-40% middle third and 30-40% in lower third

c) True

d) False-polypoid/fungating form is commonest

e) False - predisposing factors include Barrett’s oesophagus, alcohol abuse, smoking, coeliac disease, achalasia, tylosis

28
Q
  1. The following are imaging features of Candida oesophagitis on double contrast barium swallow: (T/F)

a) Granular pattern of mucosal oedema

b) Predilection for the lower third of the oesophagus

c) Discrete horizontally orientated plaque lesions

d) Diffuse shaggy oesophagus in AIDS patients with fulminant disease

e) Strictures

A

28.

a) True

b) False - upper half

c) False - longitudinally orientated

d) True

e) True – rare

29
Q
  1. The following are causes of multiple nodules in the small bowel: (T/F)

a) Nodular lymphoid hyperplasia

b) Yersinia enterocolitis

c) Canada-Cronkhite syndrome

d) Coeliac disease

e) Waldenstrom macroglobulinaemia

A

29.

a) True - multiple 2-4 mm nodules

b) True

c) True

d) False

e) True

30
Q

@# 30. Causes of small bowel strictures include: (T/F)

a) Amyloidosis

b) Potassium chloride tablets

c) Mastocytosis

d) Radiation enteritis

e) Endometriosis

A

30.

a) False

b) True

c) False

d) True

e) True

31
Q
  1. Features of Whipple’s disease include: (T/F)

a) Marked small bowel dilatation

b) Thickening of the small bowel folds

c) Delayed small bowel transit time

d) Migratory arthralgia

e) Pericarditis

A

31.

a) False

b) True - small bowel appearances of micronodularity, thickening of folds and malabsorption

c) False - normal small bowel transit time

d) True

e) True

32
Q
  1. The following statements regarding Meckel’s diverticulum are true: (T/F)

a) Identification of vitelline artery is pathognomonic

b) Is present in 2-3% of the population

c) Located in the mesenteric border of the ileum

d) In children, small bowel enema is the best investigation to identify it

e) can present as intussusception in children

A

32.

a) True

b) True

c) False - antimesenteric border

d) False - radionuclide Tc 99m pertechnetate

e) True

33
Q
  1. Complications of coeliac disease include: (T/F)

a) Ulcerative jejuno-ileitis

b) Hyposplenism

c) Small bowel lymphoma

d) Peptic ulceration

e) Oesophageal squamous cell carcinoma

A

33.

a) True

b) True

c) True - coeliac disease is also a risk factor for adenocarcinoma of the small bowel, rectum
and stomach

d) False

e) True

34
Q
  1. Features of pseudomembranous colitis include: (T/F)

a) An acute infective colitis due to Clostridium perfringens toxin

b) Most commonly affects the transverse colon

c) ‘Thumbprinting’ is seen on the plain abdominal radiograph

d) Bowel wall thickening is the commonest appearance on non contrast CT images

e) Ascites is a recognized feature

A

34.

a) False - Clostridium difficile toxin

b) False - 95% located in rectum

c) True

d) True

e) True - in severe cases, ascites is a recognized feature

35
Q
  1. Regarding ischaemic colitis: (T/F)

a) The right colon is involved in 30% of cases

b) Griffith point is the most commonly affected segment

c) Usually occurs in the first decade of life

d) Barium enema is usually only abnormal in 50-60% of cases

e) Portal vein gas is of little clinical significance

A

35.

a) True - left colon involved in 45-90%

b) True - Griffith point is the superior mesenteric artery/inferior mesenteric artery junction at the splenic flexure

c) False->50 years

d) False - 90% abnormal, features of bowel wall thickening, loss of frustrations, thumbprinting

e) False - rare but preterminal sign

36
Q
  1. Concerning adenomatous polyps of the stomach: (T/F)

a) They are benign

b) There is an association with Peutz-Jeghers syndrome

c) They are most commonly located in the fundus

d) 80% are smaller than 1 cm in diameter

e) They are usually multiple

A

36.

a) False

b) False - association with Gardner’s syndrome - It is characterized by triad of bone tumors (ie, osteoma), soft tissue tumors (ie, desmoids tumors), and GI tract polyps (including upper and lower GI tract).

c) False - most commonly located in the antrum

d) False - 80% are larger than 2 cm

e) False - usually solitary

37
Q
  1. Amyloidosis can cause: (T/F)

a) Loss of peristalsis of the oesophagus

b) Thickening of the rugae of the antrum of the stomach

c) Jejunization of the ileum

d) Hepatomegaly

e) Malabsorption

A

37.

a) True

b) True

c) True

d) True

e) True

38
Q
  1. Side effects of buscopan include: (T/F)

a) Bradycardia

b) Urinary retention

c) Acute gastric dilatation

d) Blurred vision

e) Allergic reaction

A

38.

a) False tachycardia

b) True

c) True

d) True

e) True

39
Q
  1. Complications of Crohn’s disease include: (T/F)

a) Cholangiocarcinoma

b) Chronic pancreatitis

c) Cirrhosis

d) Psoas abscess

e) Cholelithiasis

A

a) True

b) False

a) True

b) True

c) True

40
Q

@# 40. Imaging features of intussusception on plain radiograph can include: (T/F)

a) No abnormality

b) Increased gas in the stomach

c) Loss of the inferior hepatic margin

d) Small bowel obstruction in 50-60%

e) ‘Pseudokidney’ appearance

A

40.

a) True

b) False - gas-free abdomen due to excess vomiting

c) True

d) False-seen in 25%

e) False - ultrasound sign

41
Q
  1. The following statements regarding the stomach are correct: (T/F)

a) Mesentero-axial volvulus involves rotation around the line extending from cardia to pylorus

B) Hyperparathyroidism is a cause of gastric ulcers

C) Commonest location of gastric diverticulum is juxtacardia on the posterior wall

D) Rolling hiatus hernia accounts for 99% of hiatus hernias

E) Gastric ulcers above the level of the cardia are usually benign

A

a)

False - Organo-axial volvulus involves rotation around the line extending from cardia to pylorus. Mesentero-axial volvulus involves rotation around the lesser-greater curve line

b) True

c) True -75%

d) False - sliding hiatus hernia accounts for 99%

e) False - usually fundal ulcers are malignant. 5% of gastric ulcers are malignant

42
Q
  1. The following statements regarding leiomyoma of the oesophagus are true: (T/F)

a) It is the commonest benign tumour of the oesophagus

b) It rarely calcifies

c) Ulceration is common

d) It is associated with Alport’s syndrome

e) It usually involves mid and lower oesophagus

A

42.

a) True

b) False - it is the only oesophageal tumour that calcifies

c) False

d) True

e) True

43
Q
  1. Causes of smooth oesophageal strictures include: (T/F)

a) Scleroderma

b) Epidermolysis bullosa

c) Pemphigus

d) Leiomyosarcoma

e) Lymphoma

A

43.

a) True

b) True - Epidermolysis bullosa is a group of rare diseases that cause the skin to be fragile and to blister easily.

c) True - Pemphigus is an autoimmune disease in which the immune system mistakenly attacks cells in the top layer of the skin (epidermis) and the mucous membranes.

d) False

e) False

44
Q
  1. The conditions below are associated with strictures in the respective locations: (T/F)

a) Tuberculosis - ileocaecal region

b) Crohn’s disease - ileocaecal region

c) Schistosomiasis - rectosigmoid junction

d) Amoebiasis - rectosigmoid junction

e) Lymphogranuloma venereum - descending colon

A

44.

a) True

b) True

c) True

d) False - descending colon

e) False - rectosigmoid juction - Lymphogranuloma venereum (LGV) is an ulcerative disease of the genital area.

45
Q
  1. The following conditions cause lesions in the terminal ileum: (T/F)

a) Ulcerative colitis

b) Actinomycosis

c) Histoplasmosis

d) Lymphoma

e) Dermatomyositis

A

45.

a) True

b) True - though rare, it usually affects the caecum

c) True - though rare

d) True

e) False

46
Q
  1. Features more in keeping with jejunum than ileum include: (T/F)

a) 2.5 cm width diameter

b) Thicker valvulae conniventes

c) More numerous Peyer’s patches

d) One or two arterial arcades with long branches

e) Thinner walls

A

46.

a) False - ileum is 2.5 cm diameter while jejunum is 3-3.5 cm

b) True

c) False - fewer but they are larger

d) True - the ileum has 4-5 with shorter arterial arcades

e) False - thicker

47
Q

@# 47. The following statements regarding large bowel obstruction are true: (T/F)

a) Nodal non-Hodgkin’s lymphoma is a cause

b) Peritoneal carcinomatosis is a recognized cause and is most commonly secondary to uterine cancer

c) Lipoma is a recognized cause

d) Volvulus is commoner in the large bowel than the small bowel

e) Gallstones may cause large bowel obstruction

A

47.

a) True - nodes in the mesentery cause extrinsic compression

b) False- ovarian cancer

c) True - rare

d) True

e) True - usually small bowel but can cause complete block of a pathologically narrowed segment in the colon

48
Q
  1. Regarding diverticular disease: (T/F)

a) Colonic diverticulosis affects 70-80% by 80 years of age

b) 10-25% of individuals with colonic diverticular disease develop diverticulitis

c) Rectosigmoid colon is most commonly affected

d) Fistula formation occurs in 40-50% of cases complicating acute diverticulitis

e) Moderate diverticulitis is present when the bowel wall is thickened >3 mm

A

48.

a) True

b) True

c) True

d) False - 14%

e) True

49
Q
  1. Cause of dysphagia include: (T/F)

a) Candida oesophagitis

b) Enterogenous cyst

c) Chagas’ disease

d) Pseudobulbar palsy

e) Pharyngeal pouch

A

49.

a) True

b) True

c) True

d) True

e) True

50
Q
  1. Regarding complications following gastrectomy: (T/F)

a) Anastomotic leakage is most commonly seen in Billroth II surgery

b) Duodenal stump leakage usually results in abscess formation in the right subhepatic space

c) Acute intra-abdominal haemorrhage has an attenuation value of 100-120 Hounsfield units

d) Acute pancreatitis is a recognized complication

e) Local recurrence of gastric cancer most commonly involves the anastomosis/stump

A

50.

a) False - total gastrectomy - Billroth II surgery is partial gastrectomy and gastrojejunostomy

b) True

c) False - 20-40 Hounsfield units

d) True

e) True

Shahid (21 decks)

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