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FRCR Part 2a, Module 3: Gastro-intestinal & Hepatobiliary

1 CT of the abdomen
a) the liver attenuation is usually 5-10 HU higher than the spleen
b) acute hepatitis causes gallbladder wall thickening
c) biliary tree gas is a recognized finding in the Mirizzi syndrome
d) distal CBD obstruction is recognised in HIV infection

2 Regarding ERCP
a) an end-hole endoscope is required
b) it is contraindicated in acute cholangitis
c) it is contraindicated in acute pancreatitis
d) serum amylase is increased post-procedure in 20% of cases
e) in pancreas divisum the minor duct drains the ventral part

3 Angiodysplasia
a) mostly occurs in the rectosigmoid
b) is associated with Osler Weber Rendu syndrome
c) is associated with aortic stenosis
d) early filling of the draining vein is seen on angiography
e) is associated with skin lesions in 30%

4 Regarding the stomach and duodenum


a) hyperplastic polyps are associated with hyperchlorhydria
b) Brenner’s gland hypertrophy is associated with hyperchlorhydria
c) duodenal ulcers are more common on the anterior wall

5 On MRI a capsule is a recognised feature of


a) hepatic adenoma
b) focal nodular hyerplasia
c) liver metastases
d) liver abscess
e) haemangioma

6 The following can cause Budd Chiari syndrome


a) paroxysmal nocturnal haemoglobinuria
b) polycythaemia rubra vera
c) renal cell carcinoma
d) pregnancy
e) pernicious anaemia

7 The following skin lesions are associated with oesophageal disease


a) scleroderma
b) lichen planus
c) psoriasis
d) epidermolysis bullosa

8 Focal nodular hyperplasia


a) is of increased reflectivity on ultrasound
b) is hypervascular
c) is best seen on portal venous phase CT
d) is pre-malignant
e) is associated with hepatitis B infection

9 Regarding pancreatic tumours


a) gastrinoma is more common in the body and tail
b) insulinomas are hypervascular
c) ductal carcinomas are more common in the body and tail
d) insulinomas are usually single
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10 Regarding small bowel imaging


a) lymphoma typically presents with obstruction
b) a double bubble can be seen in annular pancreas
c) 75% of duodenal atresias occur just above the ampulla
d) lymphoma in patients with coeliac disease is more common in the ileum
e) lymphoma is associated with intussussception

11 Regarding MRI of capillary haemangiomas


a) prolonging the TE will increase the signal from the lesion
b) continuous peripheral enhancement is a typical feature
c) there is centrifugal progression of enhancement
d) the central area must be completely filled in to make the diagnosis
e) enhancement is persistent

12 Doppler US in the abdomen


a) The SMA waveform shows a reduction in diastolic flow post-prandially
b) The renal artery has a low resistance waveform
c) The hepatic veins have a biphasic waveform with flow reversal under the baseline
d) Acute ureteric obstruction gives high resistance flow in the kidney

13 CT of the abdomen following blunt trauma


a) haematoma of the liver is hyperdense compared to the surrounding parenchyma
b) haemorrhage can be confused with ascites
c) bowel injury is more common than mesenteric injury
d) normal pancreatic appearances on CT exclude pancreatic transection
e) oral contrast is contraindicated

14 Regarding colorectal cancer


a) 90% occur at the rectosigmoid
b) an apple core lesion carries a worse prognosis than a polypoid lesion
c) recurrence usually occurs within the first 30 months
d) synchronous adenomas occur in less than 5%

15 Cholangiocarcinoma is associated with


a) choledochal cyst
b) Caroli’s disease
c) Crohn’s disease
d) hepatitis B infection

16 Regarding percutaneous transhepatic cholangiography


a) a 22 gauge needle is suitable
b) the best approach is just posterior to the mid-axillary line
c) an approach from just inferior to the xiphisternum is useful if the left ducts are not seen
d) it is necessary when using a thin needle to aspirate to confirm position in the bile duct just prior to
injecting contrast
e) it is contraindicated in cholangitis

17 The following predispose to hepatocellular carcinoma


a) aflatoxin
b) liver parasites
c) haemochromatosis
d) malnutrition
e) oral contraceptives

18 Portal hypertension is seen in


a) systemic sclerosis
b) cystic fibrosis
c) congenital hepatic fibrosis
d) Felty’s syndrome
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19 Focal nodular hyperplasia


a) is commoner than hepatic adenoma
b) is associated with use of the oral contraceptive pill
c) is of reduced reflectivity on us
d) takes up a decreased amount of 99mTc-sulphur colloid
e) has a characteristic vascular pattern

20 In sarcoidosis
a) splenomegaly occurs
b) cardiomyopathy occurs
c) erytherma nodosum carries a poor prognosis
d) there is hypovitaminosis D

21 The following are features of Crohn’s disease


a) anal fistulae are seen more often with ileal disease than colonic disease
b) there is a wide ileocaecal valve
c) thickening of the valvulae conniventes

22 Features of oesophageal pseudodiverticulosis


a) candidiasis
b) stricture formation
c) diverticula greater than 5 mm in diameter
d) dysphagia in less than 10% patients
e) endoscopy is superior to barium swallow for demonstrating the condition

23 Fatty infiltration of the liver is seen in


a) Reye’s syndrome
b) Cirrhosis

24 Gallium-67 citrate uptake occurs in


a) normal colon
b) normal thyroid
c) an abdominal abscess
d) lymphoma
e) normal salivary glands

25 The following are criteria for oral dissolution therapy of gallstones


a) The stones are less than 5 mm diameter
b) The stones have a high bile pigment content
c) The stones have calcified surfaces
d) Normal opacification of the gallbladder on oral cholecystogram
e) Normal gallbladder contraction after a fatty meal

26 HLA-B27 antigen is associated with


a) ulcerative colitis
b) Whipple’s disease
c) Reiter’s syndrome
d) AIDS

27 The following are true of acute pancreatitis


a) pleural effusion is most commonly right-sided
b) pseudocysts may show local haemorrhage
c) gas in the pancreas is a poor prognostic sign
d) the pancreas is of increased reflectivity on US
e) the renal halo sign is positive on plain radiographs

28 Malignancy in a colonic polyp is suggested by


a) multiple polyps
b) an irregular surface
c) size greater than 1 cm
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d) an increase in size over 6 months


e) pedunculation

29 Features of Budd-Chiari syndrome include


a) atrophy of the caudate lobe
b) recanalisation of the umbilical vein
c) ascites
d) compression of the IVC
e) dilatation of the common bile duct

30 Capillary haemangioma
a) can be diagnosed on plain radiographs
b) is a recognised cause of heart failure
c) fine needle biopsy is contraindicated
d) cannot be distinguished from metastases in contrast enhanced CT
e) is of increased reflectivity on ultrasound

31 Primary carcinoid of the ileum


a) angiographic appearances are usually normal
b) is often asymptomatic
c) produces a desmoplastic reaction in the mesentery
d) may mimic Crohn’s disease
e) tumours less than 1 cm in diameter are rarely malignant

32 Aphthoid ulcers are seen in


a) radiation enteritis
b) ulcerative colitis
c) Yersinia infection
d) Herpes simplex colitis
e) solitary rectal ulcer syndrome

33 In coeliac disease
a) flattening of the villi is diagnostic
b) there is in an increased incidence of carcinoma in spite of treatment
c) jejunal ulceration is a recognised complication
d) intussusception is a recognised complication

34 In Mirizzi’s syndrome
a) There is obstruction of the common bile duct
b) A stone is impacted in Hartmann’s pouch
c) There is a predisposition to carcinoma of the gallbladder

35 Polysplenia is associated with


a) bilateral three-lobed lungs
b) agenesis of the gallbladder
c) partial absence of the IVC
d) pulmonary stenosis
e) malrotation of the gut

36 Concerning pancreatic tumours


a) islet cell tumours are hypervascular
b) microcystic tumours are hypervascular on CT
c) the majority of gastrinomas are malignant
d) macrocystic (mucinous) cystadenocarcinomas occur mostly in the head of the pancreas

37 Features of chronic pancreatitis include


a) diffuse pancreatic enlargement
b) focal enlargement simulating a carcninoma
c) focal duct dilatation is absent
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d) chronic abdominal pain


e) reduced exocrine function

38 Regarding adenomyomatosis of the gallbladder


a) foci of increased reflectivity are seen in the gallbladder wall at US
b) the gallbladder wall is thickened at US
c) it is a premalignant condition
d) there is an association with calcification of the gallbladder wall
e) it us usually found at the gallbladder fundus

39 Megacolon may be caused by


a) amoebiasis
b) Crohn’s diease
c) electrolyte imbalance
d) pseudomembranous colitis
e) purgative abuse

40 Villous adenomata
a) characteristically have a stalk
b) are malignant in 75%
c) in the right colon are not associated with electrolyte imbalance
d) are associated with Peutz-Jegher’s syndrome

41 Liver attenuation on CT is increased in


a) Alcoholic hepatitis
b) Wilson’s disease
c) Haemochromatosis
d) Pompe’s disease

42 In Barrett’s oesophagus
a) there is an increased incidence of squamous carcinoma
b) there is an ulcer in the lower oesophagus
c) there is an association with erosive arthropathy
d) strictures occur at the squamo/columnar junction
e) reflux is uncommon

43 Extramedullary haemopoiesis occurs in


a) liver
b) spleen
c) adrenal gland
d) kidney
e) small bowel

44 Achalasia
a) is most commonly idiopathic
b) is due to carcinomatous destruction of the neural plexus in the majority
c) may lead to carcinoma of the oesophagus
d) balloon dilatation is the treatment of choice

45 The following skin conditions are associated with malignancy


a) acanthosis nigricans
b) Peutz-Jegher’s syndrome
c) tylosis
d) dermatitis herpetiformis
e) pemphigus

46 Chronic calcific pancreatitis


a) can cause obstructive jaundice
b) can occur in childhood
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c) is associated with hypercalcaemia


d) is associated with pancreatic cysts

47 Primary biliary cirrhosis


a) affects men more commonly than women
b) is associated with hypertrophic osteoarthropathy
c) serum alkaline phosphatase may be raised before the onset of jaundice
d) causes intrahepatic bile duct dilatation
e) the ultrasound findings are characteristic

48 Choledochal cysts may cause the following


a) acute pancreatitis
b) increased risk of cholangiocarcinoma
c) neonatal intestinal obstruction
d) intrahepatic abscess
e) biliary cirrhosis

49 The following are true of hepatic abscesses


a) if multilocular, the appearance may simulate neoplasia
b) trauma is a recognised cause
c) the incidence is increased in patients with AIDS

50 Regarding pancreatic pseudocysts


a) spontaneous resolution occurs in 40%
b) the mortality of surgical drainage is 5-15%
c) trans-gastric drainage is contra-indicated in the acute phase
d) they may be drained at any stage

51 Hypokalaemia is a recognised feature of


a) Zollinger-Ellison syndrome
b) familial polyposis syndrome

52 Regarding metastases
a) ??GTT?? metastases to the liver may be enlarged
b) carcinoid metastases to bone are mainly sclerotic

53 Recognised features of carcinoid syndrome include


a) raised urinary vanillyl mandelic acid (VMA)
b) primary tumour usually in the appendix
c) pulmonary stenosis

54 Concerning gastric polyps


a) adenomata are pre-malignant lesions
b) Peutz-Jegher’s syndrome causes gastric adenomas
c) the histology is most frequently hyperplastic
d) adenomata are usually multiple

55 The following are true of 99mTc-pertechentate abdominal scintigraphy


a) increased activity is seen in Meckel’s diverticulum
b) increased activity is seen in acute appendicitis
c) urinary tract obstruction may be demonstrated
d) there is an accumulation of activity in duplication cysts of the gut
e) gastric uptake is a normal finding

56 Regarding scintigraphy with 99mTc-labelled red blood cells


a) gastrointestinal bleeding may be seen up to 24 hours after injection
b) a characteristic pattern of activity is seen with cavernous haemangioma of the liver
c) the extent of irritable bowel disease is accurately demonstrated
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57 Concerning Barrett’s oesophagus


a) strictures occur in the lower third of the oesophagus
b) ulceration occurs at the squamo-columnar junction
c) there is an increased risk of squamous cell carcinoma of the oesophagus
d) there is a recognised association with erosive arthropathy
e) reflux is uncommon

58 The following are features of cystic fibrosis


a) rectal obstruction
b) bowel obstruction
c) pneumothorax
d) pancreatic cysts

59 Follicular lymphoid hyperplasia


a) occurs in the ascending colon in 50% of children
b) is a recognised cause of rectal bleeding
c) is associated with dysgammaglobulinaemia
d) when on a stalk, indicated a local inflammatory response

60 Amoebic liver abscess


a) produces an area of low attenuation in the liver on CT
b) 50% of cases show calcification on CT
c) are multiple in the majority of cases
d) are diagnosed by culture of the aspirate
e) require percutaneous drainage for successful treatment

61 Primary sclerosing cholangitis


a) may precede the onset of colitis in patients with ulcerative colitis
b) causes diffuse dilatation of the intrahepatic bile ducts
c) can be reliably distinguished from cholangiocarcinoma by ERCP
d) is commoner in women

62 Endoscopic retrograde cholangiopancreatography


a) is not contraindicated by the presence of pseudocyst
b) is not possible following a Billroth I gastrectomy
c) causes increased serum amylase in the majority of cases
d) acute pancreatitis is a commoner complication in patients with a ventral pancreas
e) demonstrates a characteristic appearance in patients with annular pancreas

63 Ultrasound findings in acute infectious hepatitis include


a) increased periportal reflectivity
b) increased difference in reflectivity between liver and kidney
c) distension of the gallbladder
d) sparing of the caudate lobe

64 Pancreatic calcification is seen in


a) brucellosis
b) hyperparathyroidism
c) von Hippel Lindau syndrome
d) leishmaniasis

65 Cholangiocarcinoma
a) is hypoattenuating relative to the liver on CT
b) is hypovascular at angiography
c) shows calcification in 20% of cases
d) exhibits marked delayed enhancement on CT following IV contrast
e) autosomal dominant polycystic kidney disease is a recognised predisposing factor

66 The following are true regarding ultrasound of the liver


a) fatty infiltration appears uniform
b) the liver is of reduced reflectivity in acute hepatitis
c) amyloidosis appears as increased reflectivity
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67 Biliary tract disease may be caused by infestation with the following


a) Clonorchus sinensis
b) Taenia solium
c) ascariasis
d) Cryptosporidium
e) cytomegalovirus

68 Regarding oesophageal perforation


a) spontaneous perforation is the commonest cause
b) the distal oesophagus is the commonest site for iatrogenic peroration by endscopy
c) sub-diaphragmatic free gas is a recognised radiological finding
d) the diagnosis is excluded by a normal contrast examination

69 The following may cause an appendiceal-based filling defect on barium enema


a) carcinoid tumour of the appendix
b) mucocele of the appendix
c) appendicectomy stump
d) appendiceal abscess
e) intussussception

70 Abdominal actinomycosis
a) is associated with the presence of an intra-uterine contraceptive device
b) is commonest in the right iliac fossa
c) may cause aphthoid ulcers
d) can cause ureteric obstruction
e) is the commonest site of infection by Actinomyces

71 Regarding endocrine tumours of the pancreas


a) insulinomas are multiple in 20%
b) CT cannot demonstrate the tumour in 20%
c) there is no difference in the site of occurrence between head, body and tail

72 Adenomyomatosis of the gallbladder


a) is premalignant
b) is associated with biliary calculi
c) causes foci of increased reflectivity in the gallbladder wall
d) causes thickening of the gallbladder wall
e) is associated with gastric polyps

73 Antibiotic associated enterocolitis


a) is caused by Clostridium difficile
b) can be treated with oral clindamycin
c) causes mucosal oedema on barium enema
d) affects the bowel in short segments

74 Thickening of the valvulae conniventes is a feature of


a) sarcoid
b) scleroderma
c) carcinoid tumour
d) mastocytosis
e) amyloidosis

75 Thickened duodenal folds are seen in


a) eosinophilic enteritis
b) Zollinger Ellison syndrome
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c) scleroderma
d) mastocytosis
e) amyloidosis
f) coeliac disease
g) acute pancreatitis

76 Mastocytosis
a) causes urticaria pigmentosa
b) typically produces lytic lesions in the bones
c) is a recognised cause of small bowel nodularity
d) causes hypercalcaemia
e) is associated with epidermolysis bullosa

77 Splenic trauma
a) is associated with rib fracture in 90% of cases
b) is associated with diaphragmatic injury in 25%
c) is excluded by a normal ultrasound examination
d) is best diagnosed by contrast-enhanced CT
e) is associated with renal injury in 10%

78 Regarding actinomycosis
a) 80% of infections are intra-abdominal
b) the right iliac fossa is a common site of abdominal disease
c) aphthous ulcers are typical
d) ureteric obstruction may rarely occur
e) there is an association with intra-uterine contraceptive devices

79 Features of coeliac disease include


a) hypoglycaemia
b) osteomalacia
c) macrocytic anaemia
d) increased incidence of oesophageal carcinoma

80 Liver haemangiomas
a) are typically of increased reflectivity on ultrasound
b) are isoattenuating on unenhanced CT
c) have hyperdense septae on contrst-enhanced CT
d) take up 75Se-selenomethionine
e) are a commonly diagnosed as an incidental finding on ultrasound

81 Focal nodular hyperplasia


a) predisposes to hepatocellular carcinoma
b) is hypervascular at arteriography
c) is usually of increased reflectivity relative to normal liver parenchyma at ultrasound
d) has a capsule
e) is associated with meningioma and astrocytoma

82 Liver abscesses
a) are more common in patients with AIDS
b) may mimic metastases when multifocal
c) are uniformly enhancing on CT in 30%
d) when due to Echinococcus granulosus, have a characteristic CT appearance

83 Cholangiocarcinoma
a) presents as a large mass on CT
b) is associated with Caroli’s disease
c) is associated with primary sclerosis cholangitis
d) is associated with hydatid disease
e) involves the small intrahepatic bile ducts in 50%
84 Associations of hepatoma include
a) ascariasis
b) hydatid disease
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c) choldedochal cyst
d) cholangiocarcinoma
e) haemochromatosis

85 Massive splenomegaly is a feature of


a) non-Hodgkin’s lymphoma
b) chronic myeloid leukaemia
c) Felty’s syndrome
d) haemochromatosis
e) sickle cell anaemia

86 The liver is of increased attenuation on CT in the following conditions


a) Wilson’s disease
b) haemochromatosis
c) chronic active hepatitis
d) glycogen storage disease
e) Cushing’s syndrome
f) fatty infiltration

87 Carcinoma of the stomach


a) is commoner in patients with blood group B
b) is associated with hyperplastic polyps
c) is associated with pernicious anaemia
d) can occur following partial gastrectomy for duodenal ulcer
e) usually presents with haematemesis

88 The following are predisposing factors for hepatocellular carcinoma


a) haemochromatosis
b) Gardner’s syndrome
c) Caroli’s disease
d) Schistosomiasis

89 The following are typical features of achalasia


a) severe chest pain
b) dysphagia for liquids but not solids
c) chest infection

90 The following are causes of gas in the biliary tree


a) schistosomiasis
b) chronic duodenal ulceration
c) necrotising enterocolitis

91 Colonic angiodysplasia
a) most commonly occurs on the right side of the colon
b) is usually seen in patients over the age of 60 years
c) may cause acute gastrointestinal bleeding
d) may be diagnosed with selenomethionine scintigraphy

92 Hypoglycaemia occurs in
a) retroperitoneal sarcomas
b) islet cell tumours
c) Cushing’s syndrome
d) hyperthyroidism
e) hepatocellular carcinoma

93 Recognised features of small bowel lymphoma include


a) stricture formation
b) intramural gas
c) aneurysmal dilatation
d) Pneumoperitoneum
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94 The liver is of increased attenuation on CT in the following


a) alcoholic hepatitis
b) haemochromatosis
c) Wilson’s disease
d) amiodarone therapy
e) glycogen storage disease

95 Following hepatic artery ligation (?embolisation)


a) gas seen in the liver is not necessarily due to infection
b) there is an association with acute pancreatitis
c) portal vein thrombosis is a contraindication to the procedure
d) a decrease in plasma C-reactive protein occurs

96 The following are of increased liver reflectivity on ultrasound


a) pyogenic abscess
b) the ligamentum teres
c) haemangioma
d) hepatoma
e) untreated lymphoma

97 The incidence of gallstones is increased in


a) choledochal cyst
b) Caroli’s disease
c) sclerosing cholangitis
d) diabetes mellitus
e) Clonorchis infestation

98 The following associations are recognised


a) small bowel Crohn’s disease and carcinoma of the colon
b) adenoma sebaceum and jejunal polyps
c) melanosis coli and malignant melanoma
d) skin pigmentation and gastric carcinoma

99 In emphysematous cholecystitis, gas may be seen in


a) the gallbladder wall
b) the gallbladder lumen
c) the biliary tree
d) the pericholecystic tissues
e) subhepatic space

100 Intestinal pseudo-obstruction is associated with


a) gallbladder disease
b) oesophageal dysmotility
c) Parkinson’s disease
d) prune belly syndrome

101 Concerning chronic radiation enteritis


a) the onset occurs six months following exposure
b) the mucosa is the most severely affected layer
c) symptoms are related to radiation dose
d) the ileum is more sensitive than the jejunum
e) early surgery prevents fistulae

102 Haemangiomas of the liver


a) are of increased attenuation on ct
b) show centrifugal contrast enhancement
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c) are commonly multiple


d) are associated with Osler Weber Rendu dyndrome

103 Skin conditions with oesophageal involvement include


a) psoriasis
b) epidermolysis bullosa
c) scleroderma
d) Pemphigoid

104 Cystic fibrosis is associated with


a) intussussception
b) pancreatic calcification

105 Features of coeliac disease include


a) pancreatic calcification
b) splenic atrophy

106 Thickened, nodular duodenal folds are associated with


a) non-steroidal anti-inflammatory drugs
b) Brunner’s gland hypertrophy
c) cystic fibrosis
d) renal failure

107 Oesophageal reflux is associated with


a) scleroderma
b) para-oesophageal hiatus hernia

108 Insulinomas
a) are usually less than 15 mm is diameter
b) are of reduced reflectivity on ultrasound
c) are commoner in the head of the pancreas than in the body and tail

109 Umbilicated lesions of the stomach can be due to


a) Crohn’s disease
b) pancreatic rests
c) neurofibroma
d) gastric erosions
e) lymphoma

110 Intestinal lymphoma


a) in the small bowel is usually confined to the proximal jejunum
b) characteristically causes deeper small bowel ulcers than Crohn’s disease
c) is related to previous abdominal radiotherapy

111 Features of Mirrizi’s syndrome include


a) congenital biliary dilatation
b) a stone in the fundus of the gallbladder
c) recurrent cholangitis
d) obstructive jaundice

112 The gastric antrum may be rigid in


a) amyloid
b) cryptosporidium in a patient with AIDS

113 Whipple’s disease


a) can present with arthralgia
b) Is associated with PAS-staining tissue on microscopy
c) responds well to all antibiotic therapy
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d) causes nodular thickening of folds in the distal duodenum

114 Endoscopy is superior to barium studies in the investigation of


a) high dysphagia
b) achalasia

115 Causes of acute pancreatitis include


a) intravenous drug abuse
b) cystic fibrosis
c) mumps infection

116 Scleroderma
a) causes oesophageal strictures
b) associated with pneumothorax
c) associated with alveolar cell carcinoma
d) causes pulmonary artery hypertention
e) associated with malabsorption

117 Hypokalaemia is caused by


a) villous adenoma of the colon
b) familial polyposis coli
c) purgative abuse
d) Zollinger-Ellison syndrome

118 Acute pseudo-obstruction of the colon


a) small bowel loops may be dilated
b) barium enema is contraindicated
c) there is a risk of caecal perforation

119 Peutz-Jeghers syndrome


a) is associated with colonic cancer
b) present with GI bleed
c) polyps are mainly situated in the small bowel
d) associated with pancreatic tumour
e) polyps are adenomas

120 In acute appendicitis


a) faecolith is seen on plain film in 10%
b) mesenteric adenitis is the most common cause for false positive in children
c) enlarged mesenteric lymph nodes suggests that mesenteric adenitis is the cause

121 Pancreatic MRI


a) adenocarcinoma is characteristically hypointense on T1W and T2W
b) pseudocysts are hyperintense on T1W and T2W fat suppressed

122 Oesophagus is involved in


a) psoriasis
b) lichen planus
c) epidermolysis bullosa
d) scleroderma
e) crohn’s disease

123 Regarding small bowel lymphoma


a) diffuse wall thickening is the most common manifestation
b) there are no particular differences in imaging features between that associated with aids and general
lymphoma
c) produces generalizd atrophy of folds in proximal jejunum
d) predisposed in SLE
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124 Causes of biliary-enteric fistula


a) acute pancreatitis
b) diverticulitis
c) cholecystitis
d) Caroli’s disease
e) Crohn’s disease

125 Endoanal US
a) better at defining T1 tumour than MRI
b) internal sphincter is hyperechoic
c) external sphincter is hyperechoic
d) rectal mucosa is echogenic
e) is accurate in the assessment of anal sphincter ?function ? tear

126 MRI
a) If TE is increased then haemangiomas show increased signal on T2
b) Cavernous haemangioma show high signal on T2
c) Bone sclerosis shows signal void on T1 and T2
d) In and out of phase MRI is useful for liver steatosis
e) FNH is high signal on T2

127 Budd Chiari is associated with


a) atrophy of the caudate lobe
b) reversal of portal venous flow
c) associated with systemic hypertension
d) can be seen post bone marrow transplant

128 Raised alkaline phosphatase is seen in


a) pseudohypoparathyroidism
b) fluorosis
c) primary biliary cirrhosis
d) fibrous dysplasia
e) prosate cancer with bone metastases

129 Coeliac disease


a) is associated with colonic cancer
b) associated with oesophageal cancer
c) lymphoma usually affects terminal ileum
d) is associated with splenic atrophy
e) can be excluded on barium follow through

130 Lymphoma
a) oesophagus is the least common site of involvement
b) bowel obstruction is uncommon

131 Colonic carcinoma


a) increased survival in last 30 years
b) apple core lesion worse than polypoid cancer
c) Peutz-Jeghers is associated with ovarian cancer
d) Peutz-Jeghers is associated with carcinoid in 5%
e) 90% in rectosigmoid

132 Rectum predominantly involved in


a) Behçet’s disease
b) ulcerative colitis
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c) radiation colitis
d) pseudomembranous colitis

133 Acute pancreatitis


a) lack of enhancement on CT correlates well with necrosis
b) majority have dilated pancreatic duct
c) necrosis requires drainage
d) splenic artery aneurysm in 30%

134 angiodysplasia is associated with


a) HHT
b) aortic valve disease
c) early venous filling on angio
d) usually in the caecum

135 Barrett’s oesophagus


a) associated with squamous cell carcinoma
b) associated with stricture at squamo-columnar junction
c) scleroderma
d) dilated distal oesophagus on barium swallow
e) associated with sliding hernia

136 Pyloris stenosis


a) presents witin 2 weeks
b) pyloric diameter > 20mm
c) pyloric length of 10 mm is normal
d) associated with atonic stomach

137 The following are best seen in the arterial phase on CT


a) colonic liver metastases
b) FNH
c) hepatic adenoma
d) fatty sparing

138 MRCP
a) uses heavily T2 weighted sequence
b) previous biliary surgery is contraindicated
c) 3D images are reconstructed with MIP

139 Phaeochromocytoma
a) high urinary acetyl choline
b) average size at presentation<2cm
c) CT accurate for lesions <2cm
d) ?accuracy of venous sampling

140 Concerning balloon dilatation of oesophageal strictures


a) metal stents need endoscopic placement
b) balloon dilatation of post surgical anastomotic stricture is a contraindication
c) perforated leak can be treated with a covered metal stent
d) metal stents can erode and cause bleeding
e) can use covered metal stent in treatment of TOF

141 Coeliac disease is associated with


a) sacro-ileitis
b) lymphoma
c) markedly increased transit time in small bowel follow through
d) increased diameter of jejunum beyond 30 mm
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142 The following would be in the differential diagnosis of an isolates solitary 4 cm lesion which was hypo-
attenuating on unenhanced CT, hyper-attenuating in the hepatic arterial phase, and isointense in the
portal venous phase
a) FNH
b) hepatoma
c) focal fatty change
d) adenoma
e) cystic metastasis

143 FNH
a) hyperintense in hepatic artery phase
b) hyper intense in portal venous phase
c) mixed attenuation following iv contrast on CT
d) delayed enhancement of the central scar

144 The following is true of pancreatic tumours


a) majority of functioning islet cell tumours calcify
b) 10-15% of non functioning islet cell tumours calcify
c) 30-50% of adenocarcinomas calcify
d) calcification is seen in acute pancreatitis
e) calcification is seen in hypercalcaemia
f) calcification is seen in hyperparathyroidism

145 Regarding barium investigation of the colon


a) the only radiological changes are confined to the last 20cm of the ileum in Yersinia
b) Shigella colitis affects the caecum
c) Strongyloides infection may cause bowel fold thickening, or absence of folds in duodenum and
jejunum
d) actinomycosis affects the appendix

146 Concerning MALToma


a) is a subgroup of Hodgkin’s disease
b) predominantly affects the GIT
c) is widely disseminated in greater than 50% of patients at the time of presentation
d) there is an association with H pylori infection

147 Concerning angiodysplasia of the colon


a) most commonly presents age 30-40yrs
b) mostly affects the ascending colon
c) a draining vein is seen early in angiography
d) are multifocal in 30-40%

148 Concerning MRCP


a) bowel gas is a recognised cause of artefacts which give the impression of biliary strictures
b) MIPs are the ideal images to review to identify intra-ductal stones
c) water bowel prep improves the images
d) cholecystectomy is a CI to MRCP

149 Concerning patients presenting with gallstone ileus


a) 10-15% of stones get lodged in the duodenal bulb
b) <3% of patients presenting with SBO have gallstone ileus as the cause in the elderly
c) 80% of patients presenting with gallstone ileus have air visible in the biliary tree on plain AXR
d) ectopic GS visible on plain film in 25%
e) in patients with SBO, gas in the GB fossa is highly suggestive of the diagnosis.

150 Causes of splenic calcification


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a) sickle cell disease


b) amoebic abscess
c) hydatid disease
d) histiocytosis X

151 Regardidng hydatid disease


a) most liver lesions calcify
b) affects multiple organs in the majority
c) associated with a peripheral eosinophilia

152 PBC
a) alk phos increases characteristically before jaundice
b) associated with increased risk of HCC
c) there is bilateral intrahepatic duct dilatation on US

153 Pseudopolyposis of the colon is seen in the following conditions


a) endometriosis
b) ischaemic colitis
c) UC
d) Crohn’s

154 Colonic cancer


a) 30-40% chance of malignant involvement in a polyp bigger that 2cm
b) chances of malignancy increase if there is villous sub-type in an adenomatous polyp
c) 5-10% chance of synchronous lesion in patients with carcinoma
d) 15-20% chance of metachronous lesion in patient with carcinoma

155 Concerning the spleen the following associations are seen


a) asplenia ans right atrial isomerism
b) multifocal calcification and PCP
c) cystic metastasis and melanoma
d) coeliac disease and splenomegaly
e) sickle cell disease and increased attenuation on CT

156 Cholangiocarcinoma is associated with


a) choledocal cyst
b) UC
c) sclerosing cholangitis
d) chronic alcoholism
e) hepatitis B

157 Haemangioma of the liver


a) is the commonest benign liver lesion
b) is associated with OCP
c) hyperechoic on US with increased through enhancement
d) delayed enhancement following in enhancement

158 Concerning FAP


a) associated with duodenal carcinoma
b) desmoid tumours occur in the majority
c) characteristically the rectum is spared
d) 40% have poyps in the stomach

159 Regarding HIDA scanning


a) there is increased filling of the Gb following iv morphine
b) equally as sensitive as US and CT in detecting biliary leaks
c) failure to fill the GB in 30 mins would indicate acute cholecystitis
d) photopaenic liver lesions are best looked for at 5-10 mins post injection
e) HIDA post cholcystectomy is a contraindication

160 CT of the abdomen following blunt trauma


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a) haematoma of the liver is hyperdense compared to surrounding liver


b) haemorrhage can be confused with ascites
c) bowel injury is more common than mesenteric injury
d) normal pancreatic appearance on CT excludes pancreatic transection
e) oral contrast is contraindicated

161 Regarding pancreatic tumours


a) gastrinoma is more common in the body and tail
b) insulinomas are hypervascular
c) ducatl carcinomas are more common in body and tail
d) insulinomas are usually single

162 Regarding small bowel imaging


a) lymphoma typically presents with obstruction
b) a double bubble can be seen in an anular pancreas
c) 75% of duodenal atresias occur just above the ampulla
d) lymphoma in patients with coeliac disease is more common in the ileum
e) lymphoma is associates with intussuception

163 the following are recognised in CF


a) situs invertus
b) gallstones
c) splenic artery aneurysm
d) cirrhosis of the liver

164 Rectal carcinoma


a) 90% occur at rectosigmoid
b) an apple core lesion carries a worse prognosis than a polypoid lesion
c) recurrence usually occurs within the first 30 months
d) synchronous adenomas occur in less than 5%

165 Cholangiocarcinoma is associated with


a) choledochal cyst
b) Caroli’s disease
c) Crohn’s disease
d) Hepatitis B

166 Regarding PTC


a) 22 G needle is suitable
b) the best approach is just posterior to the mid axillary line
c) an approach from just inferior to the xiphisternum is useful if the left lobe ducts are not seen
d) it is necessary when using a thin needle to aspirate to confirm pressure in the bile ducts prior to
injecting contrast
e) contraindicated in cholangitis

167 AIDS:
a) Kaposi’s sarcoma of the stomach is associated with skin lesions in 50%
b) small bowel lymphoma shows as discrete nodules
c) herpes is the most common cause of oesophagitis
d) renal cortical calcification with PCP
e) small bowel lymphoma associated with lymphadenopathy

168 Splenic infarcts are seen in:


a) acute myeloid leukaemia
b) myelofibrosis
c) pancreatitis
d) SBE
e) polyarteritis nodosa

169 Concerning the stomach:


a) hyperplastic polyps are associated with malignancy in 10%
b) hyperchlorhydria associated with hyperplastic polyps
19

c) hyperchlorhydria associated with brunner gland hyperplasia


d) anterior wall of duodenum the commonest site of ulcers
e) 50% small bowel tumours in the duodenum

170 Pancreatitis:
a) complications seen in up to 20%
b) acute pancreatitis has a mortality of 10%
c) splenic artery complications are the most common arterial complication
d) most patients have an amylase of >500
e) associated with SMV thrombosis

171 Concerning TB of the bowel:


a) affects ileocaecal region in 90%
b) non caseating granulomas are seen
c) colon involved in entirety in 40%
d) active pulmonary disease in 2%
e) aphthous ulcers can be seen

172 Bowel fold thickening seen in:


a) renal transplant
b) extensive small bowel resection and dilatation
c) scleroderma
d) lymphangiectasia
e) giardiasis

173 Toxic megacolon seen in:


a) amoebiasis
b) typhoid
c) Hirshsprung’s
d) intussusseption
e) coeliac disease

174 The following are true associations:


a) pseudomembranous colitis and ankylosing spondylitis
b) coeliac disease and alpha 1 antitrypsin deficiency
c) adriamycin and myocardial toxicity
d) lung carcinoma and scleroderma
e) sternal depression and MVP

175 Known associations


a) candida and achalasia
b) squamous cell carcinoma and Barrett’s oesophagus
c) carcinoma of oesophagus and coeliac disease
d) adult polcystic kidney disease and increased incidence of renal cell carcinoma
e) von Hippel-Lindau syndrome and increased incidence of transitional cell carcinoma

176 Concerning HIV infection:


a) commonest pneumonia organism is pneumocystis carinii
b) commonest GI tract fungal infection is cryptococcus
c) in Kaposi’s sarcoma lung lesions occur before skin lesions
d) cerebral lymphoma ?incidence(nothing else written here)

177 Concerning pancreatic tumours:


a) macrocystic adenoma most common in the tail
b) glucagonomas are mainly malignant
c) insulinomas are hypervascular
d) encasement of SMA precludes operability
e) macrocystic adenomas are hypervascular
20

178 In HIV:
a) diffuse bowel wall involvement favours lymphoma rather than Kaposi’s
b) mycobacterium avium intracellulare causes diffuse bowel involvement
c) cryptosporidium causes cholangitis
d) candida causes typical diamond shaped ulcers in the oesophagus

179 Concerning lymphoma of the bowel:


a) oesophagus is the least common site
b) related to coeliac disease most commonly affects the distal small bowel
c) in HIV tends to affect the bowel distal to the lig of Treitz
d) bulls eye lesion typical in the stomach

180 Cystic fibrosis associations:


a) carcinoma of the pancreas
b) pancreatitis
c) intussuseption
d) infertility in men
e) renal stones

181 MEN 2 includes the following:


a) phaeochromocytoma
b) parathyroid adenomata
c) medullary carcinoma of the thyroid
d) cystic pancreatic tumours
e) pinealoma

182 Associations of malignancy:


a) psoriasis
b) Peutz Jegher’s syndrome
c) dermatitis herpetiformis
d) pemphigus

183 Budd Chiari associated with:


a) paroxysmal nocturnal haematuria
b) post partum
c) peruvian anaemia
d) polycythemia rubra vera
e) renal cell ca

184 Cholangiocarcinoma:
a) chinese > european
b) responds well to radiotherapy
c) usually presents with hepatomegaly

185 Barrett’s oesophagus:


a) squamous metaplasia
b) caused by oesophageal reflux
c) causes strictures in upper oesophagus

186 Regarding ERCP:


a) a forward viewing endoscope is required
b) gallstone pancreatitis is a contraindication
c) is a cause os gas in the biliary tree
d) bile duct stenting is indicated in the treatment of gallstones

187 Regarding carcinoid tumours:


a) the majority of lung carcinoid show endocrine activity
21

b) small bowel carcinoids metastasize to the lung


c) cause desmoplastic reaction of the mesentery
d) cause osteoblastic metastases
e) show activity at In-111 scintigraphy

188 Causes of hypercalcaemia:


a) acute pancreatitis
b) myelomatosis
c) sarcoidosis
d) amoebiasis

189 Concerning MR of the anal sphincters


a) inter-sphincter fistulas do not have to cross the external sphincter
b) the further the site of the external opening of the fistula from the anus, the more likely it is to cross the
internal sphincter
c) best sequence to assess a fistula is T1 MRI
d) fistula are echogenic on transrectal US

190 Parotid tumours:


a) greater attenuation on ct than normal parotid gland
b) pleomorphic adenomata arise in the deep lobe of the parotid gland
c) pleomorphic adenoma are the most common tumour
d) sialectasis can be caused by tumour
e) sialography is useful to differentiate benign from malignant tumours

191 In acute pancreatitis:


a) Necrosis may cause non enhancement of the pancreas
b) There is infiltration of the perirenal space

192 Regarding haemochromatosis:


a) Is associated with diabetes mellitus
b) Liver attenuation is characteristically between 60-120
c) It is associated with DIP joint arthropathy
d) The liver returns a low signal on T2

193 Cholangiocarcinoma is associated with:


a) Choledocal cyst
b) Bile duct papilloma
c) Liver fluke
d) Sclerosing cholangitis
e) Hep B

194 In primary biliary cirrhosis:


a) Increased alkaline phosphatases occurs before clinical onset of jaundice
b) Patients may develop osteomalacia
c) Cholangiography demonstrates dilated bile ducts
d) At presentation the US is usually normal
e) There is an increased risk of cholangiocarcinoma

195 central scar is associated with


a) oncocytoma
b) giant cavernous haemangioma
c) fibromellar hepatoma
d) FNH
e) Hepatic adenoma

196 The following are recognised associations:


a) candida and achalasia
b) squamous cell carcinoma and Barretts oesophagus
c) carcinoma of the oesophagus and coeliac disease.
d) adult polycystic kidney disease and an increased incidence of renal cell carcinoma.
e) von Hippel Lindau syndrome and an increased incidence of transitional cell carcinoma.
22

197 An increased incidence of cholangiocarcinomas is associated with:


a) clonorchis sinensis
b) sclerosing cholangitis
c) choledochal cyst
d) Caroli’s disease
e) inflammatory bowel disease

198 Regarding acute pancreatitis:


a) in the UK, is associated with gallstones in 70% of cases.
b) ERCP is contraindicated.
c) within 24 hours of onset, contrast enhanced CT demonstrates pancreatic necrosis.
d) if pseudocysts are not gone by 3 weeks, they are unlikely to resolve spontaneously.
e) intragastric drainage of pseudocysts are contraindicated

199 In acute pancreatitis


a) the amylase is characteristically above 500IU/ml
b) serious complications occur in 10%
c) isolated superior mesenteric vein thrombosis occurs in 30%
d) arterial involvement most commonly involves the splenic artery
e) CT is reliable in assessing necrosis

200 Causes of toxic megacolon include


a) amoebiasis
b) intussussception
c) Crohn’s disease
d) pseudomembranous colitis
e) ischaemic colitis

201 The following are correct


a) the incidence of small bowel carcinoma in coeliac disease is reduced by a gluten free diet
b) the incidence of small bowel lymphoma in coeliac disease is reduced by a gluten free diet

202 Causes of largev (> 1 cm) deep oesophageal ulcers


a) cytomegalovirus
b) herpes
c) reflux oesophagitis

203 CT features of blunt abdominal trauma


a) injury to the mesentery is more common than bowel injury
b) the left lobe of the liver is more commonly injured than the right
c) haemoperitoneum may be confused with ascites
d) periportal tracking is a recognised observation in parenchymal liver haemorrhage

204 Recognised features of appendix abscess include


a) duodenal obstruction
b) perirenal abscess
c) pyometrium
d) medial displacement of the caecum
e) narrowing of the ascending colon

205 Causes of encapsulated liver lesions on MRI


a) hepatoma
b) haemangioma
c) abscess
d) metastatic melanoma
e) adenoma
23

206 Regarding choledochal cysts


a) it is associated with upper GI haemorrhage
b) it is associated with gallbladder carcinoma

207 Peutz-Jeghers Syndrome


a) is inherited as autosomal recessive
b) has an increased incidence of adenocarcinomas of the stomach
c) the large bowel polyps are adenomas
d) presentation with major GI haemorrhage is not rare
e) there is an association with breast carcinoma

208 In the carcinoid syndrome


a) pulmonary arterial hypertension is associated
b) the appendix is the most common site of primary tumour
c) urinary VMA is increased
d) pulmonary valve fibrosis is a complication

209 The following can be seen as a diffuse increase in echogenicity on liver ultrasound
a) acute hepatitis
b) diffuse leukaemic infiltration
c) fatty infiltration
d) primary sclerosing cholangitis
e) Wilson’s disease

210 Decreased motility in the upper third of the oesophagus is seen in


a) dermatomyositis
b) scleroderma
c) dystrophia myotonica
d) bulbar palsy secondary to CVA
e) myasthenia gravis

211 Pneumatosis intestinalis is associated with


a) asthma
b) scleroderma
c) pneumoperitoneum
d) cystic fibrosis
e) amyloidosis

212 Adenomyomatosis
a) is premalignant
b) is associated with gallstones
c) ultrasound shows gallbladder wall thickening
d) is associated with gastric polyps
e) on ultrasound shows intramural reflective foci

213 Chronic alcoholism is associated with


a) hypertrophic pulmonary osteoarthropathy
b) a syrinx
c) osteoporosis
d) pneumatosis coli
e) carcinoma of the oesophagus

214 Coeliac disease is associated with


a) oesophageal carcinoma
b) ulcerative colitis
c) Increased small bowel transit time
24

d) intussusception
e) atrophic spleen

215 Menetrier’s disease


a) usually affect the gastric antrum
b) is associated with apthous ulceration on hypertrophied rugal folds
c) is more common in women
d) is associated with an increased risk of gastric carcinoma

216 Villous adenoma


a) coats poorly with barium
b) commonly causes hypoproteinaemia
c) is usually sessile
d) is usually multiple

217 Concerning pancreatic tumours


a) non enhancement of a portion of the gland is associated with necrosis
b) is associated with hypercalcaemia
c) serous adenoma carcinomas are more common in women
d) microcystic carcinoma is commoner in women
e) 90% of carcinomas are cystic

218 In AIDS
a) CMV affects the small bowel more frequently than the large bowel
b) CMV is the commonest cause of oesophagitis
c) PCP is the commonest cause of pneumonia
d) cryptosporidium can cause cholangitis
e) pseudodiverticular of the oesophagus can occur

219 Alpha-1 antitrypsin deficiency is associated with


a) emphysema
b) carcinoma of the lung
c) cirrhosis
d) pancreatitis
e) hepatocellular carcinoma

220 Haemochromatosis is associated with


a) calcification of the triangular ligament
b) osteoarthritis of the distal interphalangeal joints
c) the liver shows increased signal on T2 weighted images
d) cardiomyopathy
e) testicular atrophy

221 On ultrasound of the liver the following are of low echogenicity


a) abscess
b) lymphoma
c) haemangioma
d) colonic metastases

222 Causes of splenic calcification include


a) amoebiasis
b) histoplasmosis
c) sickle cell disease
d) hydatid disease
e) tuberculosis

223 In the immunocompromised patient


a) CMV is the most common form of oesophagitis.
25

b) intramural pseudodiverticulosis is a recognised association.


c) CMV more commonly affects the large bowel than the small bowel.
d) cryptosporidium typically causes small bowel fold thickening.
e) PCP is the commonest cause of pneumonia.

224 Chronic panceratitis


a) the inherited form is associated with an increased incidence of carcinoma of the pancreas.
b) abdominal pain is present in > 50%
c) most have impaired exocrine function if calcification is seen on plain film.
d) associated with scurvy
e) onset occurs in childhood with the inherited form.

225 Chronic volvulus.


a) involves the transverse colon in 4%
b) caecal volvulus is commoner than sigmoid.
c) there is a positive association with a high fibre diet
d) there is a positive association with anti-depressants
e) is associated with scleroderma.

226 The differential diagnosis of a colonic stricture includes


a) amoebiasis
b) lymphogranuloma venereum
c) giardiasis
d) steroid enemas
e) TB

227 Gallium 67 is taken up by


a) abscess
b) sarcoid
c) bronchial ca
d) lymphoma
e) hepatoma

228 increased periportal reflectivity is seen in


a) metastases
b) amoebic abscesses
c) schistosoma mansonii
d) sclerosing cholangitis
e) recurrent pyogenic cholangitis

229 Retroperitoneal fibrosis


a) commonly have back pain
b) ureteric catheterisation is difficult
c) may cause IVC compression
d) is usually unilateral
e) medial deviation of the caecum is recognised

230 Metallic endoprosthesis for billiary stenting, when compared to plastic stents
a) are less likely to block due to bile encrustation
b) are easier to remove
c) are more likely to dislodge
d) can be put through a smaller percutaneous hole
e) can only be used in straight segments because of a lack of longitudinal flexibility.

231 Hepatic adenoma


a) are associated with haemoperitoneum
b) have increased activity on a sulphur colloid scan
c) are vascular at angiography
d) rim calcification at CT is recognised
e) spontaneous regression is recognized
26

232 Causes of gallbladder wall thickening of >2mm include


a) retroperitoneal fibrosis
b) extrahepatic portal vein obstruction
c) ymphatic obstruction at the porta
d) inadequate fasting
e) cardiac failiure

233 Massive splenomegaly occurs in


a) myelofibrosis
b) CML
c) NHL
d) Felty’s syndrome
e) haemochromatosis

234 Acute pancreatitis is associated with


a) steroids
b) NAI
c) abdominal radiotherapy
d) spenectomy
e) surgical exploration of the CBD

235 The following may show as stellate masses in the liver on CT


a) oncocytoma
b) focal nodular hyperplasia
c) heamangioma
d) colonic metastases
e) fibrolamellar hepatoma