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1
Q

Small bowel fold reversal with flocculations and sedimentation
Moulage sign
No bowel wall thickening

A

Celiac sprue

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2
Q

Heptomegaly with decreased echogenicity
Periportal edema

A

Viral hepatitis

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3
Q

Tender hepatomegaly
Hepatic veins and IVC enlarged
Congestive heart failure
Nutmeg liver
Increased portal vein pulsatility

A

Passive hepatic congestion

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4
Q

Nuclear medicine uptake for carcinoid

A

111 I-octreotide
If uptake not there- 123 I-MIBG

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5
Q

Ring like indentations of esophagus
With atopy symptoms

A

Idiopathic eosinophilic esophagitis

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6
Q

Ulcer at sites of extrinsic compression in mid esophagus

A

Drug induced esophagitis

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7
Q

Long structure
Reticular mucosal pattern of esophagus
Columnar metaplasia of distal esophagus in response to reflux

A

Barrett esophagitis

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8
Q

Ingestion of corrosive substance
Mid and lower third of esophagus affected
Progression from edema to ulceration to scarring over days

A

Caustic esophagitis

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9
Q

One large longitudinal ulcer in esophagus

A

CMV/HIV

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10
Q

Immunocompromised patients
Flu-like symptoms
Multiple small ulcers , each may have a halo of edema

A

Herpes simplex

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11
Q

Pt with AIDS
Shaggy outline from a pseudomembrane of joined together plaques

A

Fulminant candidiasis

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12
Q

Irregular longitudinal plaques with normal mucosa in between
Upper half of the esophagus
Immunocompromised

A

Candidiasis

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13
Q

Multiple elevated benign nodules in asymptomatic elderly patients -rounded

A

Glycogen acanthosis
D/d - candidiasis : has linear rather than rounded

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14
Q

Nerve innervating esophagus

A

Vagus

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15
Q

Multiple polyps in stomach and colon
Alopecia
Nail atrophy

A

Cronkhite Canada syndrome

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16
Q

Portal venous pulsatality causes

A

Right sided heart failure
Tricuspid regurgitation
Cirrhosis

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17
Q

Location of primary duodenal diverticulum

A

Unilocular lesion adj to medial wall of second part of duodenum with fluid level within it

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18
Q

Peutz Jeghers

A

Carcinomas- upper GI, ovary, thyroid,testis, pancreas, breast least common-lung . RCc not seen
Multiple hamartomatous polyps- present in small bowel -few pedunculated causing intussusception
Mucocutaneous pigmentation

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19
Q

Whipples disease

A

Sand like nodules in the duodenum and prox jejunum
Jejunal mucosal folds thickened
Low near fat density LN
No dilatation unlike scleroderma
Normal transit time unlike scleroderma(delayed due to dilated bowels)

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20
Q

Mastocytosis

A

Nodular fold thickening
Sclerotic bone lesions
Asthma type symptoms( mast cells)
Hepatosplenomegaly
LN enlargement

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21
Q

Carney triad

A

PEG
Pulmonary chondromas
GIST
Extra adrenal paraganglioma

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22
Q

Carney syndrome

A

Atrial myxoma
Facial/buccal pigmentation
Sertoli testis
Pituitary adenoma

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23
Q

Bezoar types

A

Phytobezoar-mottled filling defects
Trichibezoir- linear filling defects

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24
Q

Bouveret syndrome

A

Akin to gallstone ileus where the level of obstruction is the proximal duodenum and there is gastric outlet obstruction

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25
Q

Early opacification of ileocolic vein with cluster of vessels in the antimesenteric border

A

Angiodysplasia

26
Q

High output CHF
Large heart on chest x ray
Skin hemangioma
Kasabach meritt syndrome -thrombocytopenia
What liver mass do u see in infants

A

Hemangioendothelioma
Or infantile hepatic hemangiom

27
Q

Childhood liver mass
Elevated AFP
Calcification
May involve portal vein, hepatic veins and ivc
Precocious puberty from making beta HCG
Beckwith- weidemann syndrome- so ass with Wilms

A

Hepatoblastoma

28
Q

Childhood- liver
Predominantly cystic mass
AFP negative
Calcificaitions not present
Large portal vein branch feeding the tumor

A

Mesenchymal Hamartoma

29
Q

Differences between epiploic appendagitis and omental infarction

A

EA-1. <3 cm,2. Most commonly adj to the sigmoid or cecum, 3. Shorter history
OI- 1. >3cm, 2. In right Lower quadrant ,3. Longer history

30
Q

Skeletal osteomas
Keloid scarring
Soft tissue tumors like desmoid of meant, lipoma, fibroma
Supernumerary teeth

A

Gardner syndrome

31
Q

Rectosigmoid polyp
Fibrocystic disease/ fibroadenoma of breast
Dysplastic cerebellar gangliocytoma- Lhermitte Duclos disease
Skin disease in head and face called trichilemmomas

A

Cowden syndrome

32
Q

Adenomatous and largely colonic polyps which can lead to cancers
Brain tumors- supratentorial glioblastoma or medulloblastoma

A

Turcot syndrome

33
Q

Innumerable Hamartomatous polyps
Pedunculated polyps leading to intussusception
Mucocutaneous melanin pigmentation

A

Peutz jeghers

34
Q

Carpet of colonic polyps
Periampullary carcinoma
Hepatoblastoma
Osteoma
Dental anomalies
JNA
Papillary thyroid carcinoma

A

FAP

35
Q

CT may demonstrate thickening of the caecum as well as fat stranding, pneumatosis intestinalis, bowel wall thickening and ileus. Features of small bowel obstruction may also be seen. There may be intramural areas of low attenuation which may represent haemorrhage or oedema.
In general patients are immunocompromised, usually neutropenic.

originates in the caecum and, often extends into the ascending colon, appendix or terminal ileum,

A

Typhilitis

36
Q

Abscess formation within abdomen
With fistula
Involvement of psoas
Prev history of ruptured appendix
Or IUCD usage

A

Actinomycosis

37
Q

Homogenous hypoechoic lesion with internal echoes and contiguous with the liver capsule

A

Amoebic abscess- usually single unlike pyogenic abscess, amoebic is found in slightly younger patients-40ys
Pyogenic abscess- septicemia , direct spread, trauma, liver procedure
Both can have fever

38
Q

Congestive heart failure
Constrictive pericarditis
Dilated hepatic veins
Portal vein- increased pulsatality
Nutmeg liver

A

Passive hepatic congestion

39
Q

Small hepatic venules
Normal ivc and hepatic veins
Portal vein waveform abnormal - slow, reversed, to and fro

A

Hepatic veno occlusive disease

40
Q

Causes of increased density of liver in ct

A

Amiodarone therapy
Haemochromatosis
Historic thorotrast admission
Wilson disease

41
Q

Causes of increased density of liver in ct

A

Amiodarone therapy
Haemochromatosis
Historic thorotrast admission
Wilson disease

42
Q

Narrow caliber (2-4mm) smooth, symmetrical narrowing at distal GEJ
Dysphagia to solids esp steak

A

Schatzki ring or B ring
Notes: a ring is origin of vestibule - 2 cm above hiatus

43
Q

Zenker diverticulum vs Killian Jamieson pulsion diverticulum

A

Z- above cricopharynx involving hypopharynx(not cervical esophagus), its posterior
KJ- below cricopharynx, involved cervical esophagus - its anterior and lateral

44
Q

Retention of barium in vallecula
Wide atonic pyriform fossa
Regurgitation and nasal reflux
Upper 1/3rd of esophagus affected

A

Polymyositis

45
Q

Mega esophagus
Mega duodenum
Looks like achalasia
Periorbital or palpable edema/conjunctivitis

A

Chagas disease

46
Q

Hypertrophic pyloric stenosis cut offs

A

π = 3.1415

pyloric muscle thickness, i.e. diame­ter of a single muscular wall on a transverse image >3 mm (most accurate 1)
pyloric transverse diameter ≥14 mm
length, i.e. longitudinal measurement >15 mm

47
Q

Hyperechoic area in right lobe of liver in a previously well pt with posterior acoustic enhancement

A

Capillary hemangioma

48
Q

Contraindications for liver biopsy-

A
  1. Uncooperative patient
  2. Extrahepatic biliary duct dilatation (except if benefit outweighs the risk)
  3. Bacterial cholangitis (relative contraindication due to risk of septic shock)
  4. Abnormal coagulation indices (having a normal INR or PT is not a reassurance that the patient will not bleed; however, there is increased incidence of bleeding with INR above 1.5)
  5. Thrombocytopenia (platelet count below 60,000/mm’)
  6. Prsence of ascites
  7. Cystic lesion
49
Q

Tumor markers
1. AFP
2. CEA
3. Beta HCG
4.calcitonin
5. Ca 15-3
6. CA 19-9

A

Ans

  1. AFP- primary hcc
  2. CEA- colorectal carcinoma
  3. Beta HCG-choriocarcinoma
    4.calcitonin- medullary carcinoma
  4. Ca 15-3- breast
  5. CA 19-9- pancreatic and gastric
50
Q

Infectious colitis organisms which cause on the right and left

A

Right side- yersinia and salmonella(note- salmonella can cause acute acalculus cholecystitis
Left side - schistosomiasis, shigella
Diffuse- cmv and E. coli
Rectosigmoid- gonorrhae , herpes and chlamydia

51
Q

Rectal carcinoma is it adenocarcinoma or squamous

A

Almost always adenocarcinoma
If squamous- hpv
If muscularis mucosa is involved - t3–> neoadjuvent chemo/radio , then resection
If low grade cancer but with involvement of spread along the vessels( question will give fusiform dilatation of the sup rectal vein/ micronodularity along the vascular pedicle—> neoadjuvant chemo

52
Q

TIPS contraindications

A

ABSOLUTE
Severe heart failure
Mild progressive liver failure: MELD score>18 or child Pugh class C, total bilirubin >3 mL/dl
Severe encephalopathy
Severe infection (uncontrolled systemic infection)
RELATIVE
Cavernous transformation of portal vein
Severe hepatic encephalopathy

53
Q

Multiracial structures of intra and extra hepatic biliary ducts
Ass with inflammatory bowel disease

A

Primary sclerosing cholangitis
Dd : primary biliary cirrhosis - only intrahepatic ducts are dilated , Middle Ages women , ass with RA, scleroderma , hashimotos . It has a ring like right lobe which looks like a pseudo tumor with a shrunken left lobe

54
Q

Post cholecystectomy
Persistent bile leak

A

Duct of lushka/ accessory subvesicular

55
Q

abdominal ultrasound scan on a woman who has been complaining of chronic abdominal pain. There is a large 20 cm multiloculated, ovoid anechoic mass in the right lobe of liver. The internal septations are well visualised and hyperechoic. Further investigation with CT demonstrates enhancement of its thick wall and internal septations.

A

Biliary cystadenoma

56
Q

Liver mets from colorectal carcinoma
Criteria for resectability

A

A. There is no strict limit on the number of lesions that can be removed, but it is unlikely that more than 6 will be removed
B. At least three segments spared from metastatic involvement
C. No visible nodal involvement
D. At least one main portal vein branch must be spared
E. At least one hepatic vein must be spare

57
Q

Normal findings post liver transplant

A

Both increased periportal attenuation and periportal edema
Minimal ascites
Right sided pleural effusion
Perihepatic hematoma

58
Q

A 66-year-old man is admitted to ITU following complications during his recent coronary artery bypass grafting. He is intubated and ventilated but his doctors notice abdominal distension and elevation of his inflammatory markers and arterial blood sampling shows elevation of his serum lactate. He undergoes a CT scan which shows mucosal hyperenhancement and thumbprinting of the transverse colon and splenic flexure.
Which of the following is the most likely explanation for these findings?
Coeliac axis stricture
Hypotension
Inferior mesenteric artery thrombus
Internal iliac artery stricture
Superior mesenteric artery thrombus

A

Hypotension / hypoperfusion

Watershed areas ( splenic flexure and rectosigmoid junction ) or whole bowel

Cecum to splenic flexure- SMA
Splenic flexure to rectum - IMA

59
Q

Rectal carcinoma most common type

A

Adenocarcinoma
If squamous cell - HPV

60
Q

A 76-year-old lifelong smoker visits his GP complaining of intermittent crampy abdominal pain. His GP suspects he may have mesenteric angina and arranges for a gastroenterological review as well as a CT mesenteric angiogram. The CT suggests ischaemia affecting the descending colon and splenic flexure.
Which of the following findings would be most consistent with a diagnosis of mesenteric angina?
Mesenteric vein gas
Mural thickening
Pneumatosis coli
Portal venous gas
Smooth stricture

A

Smooth stricture

Mesenteric angina is a clinical syndrome caused by episodic sup-optimal perfusion of the small or large bowel.
This typically occurs in the post-prandial setting when the oxygen requirements of the stomach increase and it
‘steals’ the blood supply from the stenotic, compromised supply to the rest of the bowel. The radiological findings are akin to a chronic type of mesenteric ischaemia or ischaemic colitis. Chronic ischaemia leads to stricturing and, unlike malignant strictures, these will be smooth in nature. By contrast, the other features listed can all be found in an acute setting

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