GIT

Question 1

1. The following statements regarding acute pancreatitis are correct:
   (a) Mumps is a recognised cause.
   (b) Pancreatic necrosis demonstrated on CT is associated with a mortality of 5-10%.
   (c) Pancreatic oedema is a late sign.
   (d) Haemorrhagic pancreatitis is diagnosed by the presence of hypodense areas of 5-20 Hounsfield units on CT.
   (e) Right-sided pleural effusion is seen in 5%.

Answer 1

Answers:
(a) Correct
(b) Not correct
(c) Not correct
(d) Not correct
(e) Not correct
Explanation:
Alcohol and gallstones on the commonest cause of acute pancreatitis.
Left-sided pleural effusion is seen commonly.
Pancreatic oedema is the earliest sign of acute pancreatitis.
Haemorrhagic pancreatitis is diagnosed by the presence of hyperdense areas.

Question 2

2. Regarding hepatocellular carcinoma:
   (a) Haemochromatosis is a recognised cause.
   (b) It is the commonest primary visceral malignancy in the world.
   (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.

Answer 2

Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Correct
(e) Not correct
Explanation:
Causes of hepato-cellular carcinoma are haemochromatosis, cirrhosis, hepatitis, Wilson’s disease, alpha 1 antitrypsin
deficiency .
Elevated alpha feto-protein levels are found in 50-60% cases of hepato-cellular carcinoma.
On MRI, hepatoma shows increased signal intensity on T2-weighted images with peripheral gadolinium enhancement
in 20% of the cases.

Question 3

3. Regarding pancreatic islet cell tumours:
   (a) Insulinoma is found predominantly in the pancreatic body and tail.
   (b) Glucagonoma is the commonest functioning islet cell tumour.
   (c) Glucagonoma is a hypervascular tumour.
   (d) Glucagonoma undergoes malignant transformation in 5-10%.
   (e) Multiple insulinomas are associated with MEN Type 1.

Answer 3

Answers:
(a) Not correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Correct
Explanation:
Insulinoma does not have any predilection for any part of the pancreas. The undergo malignant transformation in 5-
10% of the cases.
Glucagonoma is the second commonest functioning islet cell tumour. The hypervascular and undergoes malignant
transformation in 80% of the cases.

Question 4

4. The following statements regarding splenic lymphoma are correct:
   (a) The spleen is involved at presentation in 30-40% of patients with non-Hodgkin’s lymphoma.
   (b) When there is lymphomatous involvement of the spleen, splenomegaly is seen in 70-80%.
   (c) Focal splenic deposits are usually well defined, round lesions of increased brightness on ultrasound.
   (d) Splenic lymphoma deposits commonly calcify.
   (e) Lymph nodes are seen in the splenic hilum in 50% of patients with Hodgkin’s lymphoma.

Answer 4

Answers:
(a) Correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Not correct
Explanation:
Splenic lymphoma shows focal deposits which are usually well defined and hypoechoic on ultrasound.
When there is lymphomatous involvement of the spleen, splenomegaly is seen in the percent of the cases. In patients
with Hodgkin’s lymphoma, lymph nodes are seen in the splenic hilum in 10-20% of the patients.

Question 5

5. Regarding Budd-Chiari syndrome:
   (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) A ‘spider’s web’ appearance at hepatic venography characteristic.
   (e) On MRI images ‘comma-shaped’ intrahepatic collateral vessels are seen.

Answer 5

Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Correct
(e) Correct
Explanation:
Caudate lobe is enlarged and hypertrophied in Budd chiari syndrome .
Flip-flop enhancement pattern is seen with central hepatic enhancement in the early phase and peripheral enhancement
in the late phase.
Thrombosis in hepatic veins is more common cause than obstruction of the suprahepatic IVC.

Question 6

6. The following statements concerning oesophageal carcinoma are correct:
   (a) 90% of cases are squamous cell carcinomas.
   (b) Most commonly located in the upper third of the oesophagous.
   (c) Plummer-Vinson syndrome is a recognised predisposing factor.
   (d) It is associated with ulcerative colitis.
   (e) Commonest appearance on double contrast barium swallow is of a large ulcer within a bulging mass.

Answer 6

Answers:
(a) Correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
Oesophageal carcinoma most commonly located in the middle and lower third of the oesophagus. Only 20% occur in
the upper one third .
Polypoidal or fungating form is the commonest type.
Predisposing factors for oesophageal carcinoma include Barrett’s esophagus, alcohol abuse, smoking, coeliac disease
& Achalasia.

Question 7

7. The following statements regarding Meckel’s diverticulum are correct:
   (a) Is present is 2-3% of the population.
   (b) Identification of Vitelline artery is pathognomonic.
   (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

Answer 7

Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Meckel’s diverticulum located at the antimesenteric border of the ileum.
Best investigation diagnosed Meckel’s diverticulum in children is a radionuclide technetium 99 pertechnetate scan.

Question 8

8. Features of pseudomembranous colitis include:
   (a) An acute infective colitis due to Chostridium perfringens toxin.
   (b) Most commonly affects the transverse colon.
   (c) Bowel wall thickening is the commonest appearance on non-contrast CT images.
   (d) ‘Thumbprinting’ is seen on the plain abdominal radiograph.
   (e) Ascites is a recongnised feature.

Answer 8

Answers:
(a) Not correct
(b) Not correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
Pseudomembranous colitis is caused by Clostridium difficile toxin.
It most commonly affects the rectum.
Ascites is a recognised feature in severe cases

Question 9

9. Regarding ischaemic colitis:
   (a) Griffith point is the most commonly affected segment.
   (b) The right colon is involved in 30% of cases.
   (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.

Answer 9

Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Not correct
Explanation:
Ischaemic colitis is usually seen in patients >50 years of age .
Barium enema is abnormal in 90% of the cases showing features of bowel wall thickening, loss of haustrations and
thumbprinting.
Evidence of portal vein gas is seen in very rae cases and is a preterminal sign.

Question 10

10. Features more in keeping with jejunum than ileum include:
    (a) Thinner walls.
    (b) Thicker valvulae conniventes.
    (c) More numerous Peyer’s patches.
    (d) One or two arterial arcades with long branches.
    (e) 2.5cm width diameter

Answer 10

Answers:
(a) Not correct
(b) Correct
(c) Not correct
(d) Correct
(e) Not correct
Explanation:
Ileum is 2.5 cm in diameter and jejunum is 3-3.5 cm.
Jejunum shows a few Peyer’s patches but they are larger.
Jejunum as thicker walls as compared to ileum.

Question 11

11. Regarding diverticular disease:
    (a) Colonic diverticulosis affects 70-80% by 80 years of age.
    (b) Rectosigmoid colon is most commonly affected.
    (c) 10-25% of individuals with colonic diverticular disease develop diverticulitis.
    (d) Fistula formation occurs in 40-50% of cases complicating acute diverticulitis.
    (e) Moderate diverticulitis is present when the bowel wall is thickened >3mm.

Answer 11

Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Not correct
(e) Correct
Explanation:
Fistula formation is seen in 15% of the cases of complicated acute diverticulitis.

Question 12

12. Regarding Peutz-Jeghers syndrome:
    (a) It is inherited in an autosomal recessive manner.
    (b) There is an association with intussusception.
    (c) Patients are at increased risk of gastrointestinal adenocarcinoma.
    (d) Polyps are seen in the stomach.
    (e) It is associated with pigmented lesions on the fingers

Answer 12

Answers:
(a) Not correct
(b) Correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
It is an autosomal dominant disease showing polyps in stomach, small intestine especially jejunum and may be seen in
colon.
There is an increased risk of a adenocarcinoma but polyps themselves are hamartomatous and benign.

Question 13

13. Regarding Carcinoid tumour:
    (a) Carcinoid syndrome is the presentation in only 20-30% of cases.
    (b) It is rarely multiple.
    (c) The commonest location for this tumour is the appendix.
    (d) 50% of tumours greater than 2cm in size have metastases.
    (e) Angulation of small bowel loops on small bowel follow through is a diagnostic feature.

Answer 13

Answers:
(a) Not correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Correct
Explanation:
Carcinoid tumour are multiple in 33% of the cases. Carcinoid syndrome is seen in only 7% of the cases and arises
due to excess serotonin levels.
The 50% of tumours of 1–2 centimetres in size have metastasis, 85% of tumour was greater than 2 cm have
metastasis.

Question 14

14. The following statements regarding Achalasia are correct:
    (a) Dilatation of the oesophagus begins in the upper third.
    (b) Multiple non-peristaltic contractions are seen on barium swallow.
    (c) A prominent gastric air bubble is seen on erect CXR.
    (d) There is an association with plummer-Vinson syndrome.
    (e) Squamous cells carcinoma of the oesophagus is a recognised complication

Answer 14

Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Achalasia is not associated with Plummer-Vinson syndrome.
Gastric air bubble is usually absent on erect chest x-ray.
Dilatation of the oesophagus begins in the upper one third and progresses to involve the entire length

Question 15

15. Following statements regarding lymphoma of the gastrointestinal tract are correct:
    (a) There is an increased risk associated with ulcerative colitis.
    (b) The stomach is the most common site of involvement by non-Hodgkin’s lymphoma.
    (c) In the colon the rectum is most commonly involved.
    (d) Diffuse involvement of the whole stomach is seen in 10-15%.
    (e) Presents with thickened valvulae conniventes in the small bowel.

Answer 15

Answers:
(a) Not correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Lymphoma of the gastrointestinal tract has an increased risk association with Crohn’s disease, coeliac disease, AIDS
and SLE.
Diffuse involvement of the stomach is seen in 50% of the cases.
Caecum is most commonly involved in colon

Question 16

16. Regarding peritoneal spaces:
    (a) The right subhepatic space communicates with the lesser sac.
    (b) The left subphrenic space is separated from the right subphrenic space by the falciform ligament.
    (c) The bare area of the liver is located between reflections of the right and left coronary ligaments.
    (d) The splenorenal ligament separates the left subphrenic space from the left paracolic gutter.
    (e) The gastrocolic ligament connects the lesser curve of the stomach to the superior aspect of the transverse colon.

Answer 16

Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
Phrenico-colic ligament separates the left subphrenic space from the left paracolic gutter since it attaches to the
descending colon to the left hemidiaphragm .
The gastrocolic ligament connects to the greater curvature of the stomach to the superior aspect of the transverse
colon.

Question 17

17. Regarding gastrointestinal stromal tumours (GIST):
    (a) The most significant criteria for predicting malignant potential is tumour size.
    (b) It is a cause of haematemesis.
    (c) The commonest location is the sigmoid.
    (d) There is an association with neurofibromatosis Type 1
    (e) Contrast enhancement is invariably uniform.

Answer 17

Answers:
(a) Correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Not correct
Explanation:
Gastrointestinal stromal tumour does not cause hematemesis since they are mostly exophytic.
It is commonly located at stomach. There is heterogenous enhancement with significant haemorrhage and necrosis.

Question 18

18. Regarding hepatic adenoma:
    (a) It is associated with Type 1 glycogen storage disease.
    (b) Is located in the left lobe of the liver in 60-75% of cases.
    (c) Is easily differentiated from hepatocellular carcinoma on MRI.
    (d) Often reduces in size during pregnancy.
    (e) Is hypovascular.

Answer 18

Answers:
(a) Correct
(b) Not correct
(c) Not correct
(d) Not correct
(e) Not correct
Explanation:
Hepatic adenoma increases in size during pregnancy.
There are hypervascular lesions with significant risk of bleeding at the biopsy and hence biopsy is contraindicated.
There are indistinguishable on all MRI sequences.
There mostly located in the right lobe of liver in 60-75% of the cases

Question 19

19. The following statements regarding primary sclerosing cholangitis are correct:
    (a) The common bile duct is usually spared.
    (b) It affects only the intrahepatic bile ducts.
    (c) Echogenic portal triads are identified on ultrasound.
    (d) There is a 10-15 times increased risk of developing cholangiocarcinoma.
    (e) It is associated with positive antimitochondrial antibodies.

Answer 19

Answers:
(a) Not correct
(b) Not correct
(c) Correct
(d) Correct
(e) Not correct
Explanation:
Primary biliary cirrhosis is associated with positive antimitochondrial antibodies.
Primary sclerosing cholangitis affects intra-and extrahepatic bile ducts.
Common bile duct is always involved.

Question 20

20. which of the following statements are correct about Insulinomas:
    (a) The majority are benign.
    (b) 90% are less than 2cm in diameter.
    (c) Are frequently multiple.
    (d) Are associated with MEN 1 syndrome.
    (e) More than 50% can be localized using an octreotide scan.

Answer 20

Answers:
(a) Correct
(b) Correct
(c) Not correct
(d) Correct
(e) Correct
Explanation:
Only 10% of insulinomas are multiple. When multiple, the individual lesions are smaller. Malignant lesions tend to be
larger than benign.
Patients with MEN 1 syndrome tend to have multiple small insulinomas

Question 21

21. Focal nodular hyperplasia (FNH):
    (a) Multiple lesions are seen in 40-60% of cases.
    (b) Is the most common benign liver tumour.
    (c) Has a low signal on T2 weighted MRI post-iron oxide administration.
    (d) Central scar is a pathognomonic feature.
    (e) Central scar is hyperdense on arterial phase CT.

Answer 21

Answers:
(a) Not correct
(b) Not correct
(c) Correct
(d) Not correct
(e) Not correct
Explanation:
FNH is the second most common benign liver tumour after haemangioma. The usually occurs in young patients with
more female ratio.
There are multiple in 20% of the cases.
A central scar is usually seen in FNH however it can be seen in giant haemangioma, hepato cellular carcinoma and
hepatic adenoma.
Central scar of FNH is non-enhancing on arterial phase however the rest of the tumour enhances significantly

Question 22

22. Which of the following are correct about Crohn’s disease:
    (a) There is an increased risk of malignancy.
    (b) Pseudo-diverticula are typically found on the antimesenteric side of the bowel.
    (c) Mural stratification on CT indicates active disease.
    (d) Colonic involvement is usually accompanied by small bowel disease.
    (e) Apthous ulcers are an early finding.

Answer 22

Answers:
(a) Correct
(b) Correct
(c) Correct
(d) Correct
(e) Correct
Explanation:
The comb sign in crohn’s disease depicts the pericolic and perienteric fat stranding due to increased mesenteric
vasculature.
Disease can affect any part of the gastrointestinal tract from mouth to the anus however small intestine is most
frequently involved particularly the terminal ileum

Question 23

23. Which of the following are correct about Emphysematous cholecystitis:
    (a) Gallstones are present in over 90% of cases.
    (b) The most common causative organism is staphylococcus aureus.
    (c) Is associated with diabetes in 5-10% of cases.
    (d) Intramural gas is characteristic.
    (e) Is usually successfully treated with antibiotics alone.

Answer 23

Answers:
(a) Not correct
(b) Not correct
(c) Not correct
(d) Correct
(e) Not correct
Explanation:
Emphysematous cholecystitis is most commonly caused by clostridia and E.Coli species.
It commonly affects order men and has association with diabetes mellitus in about 50% of the cases.
Gallstones are present less frequently. It can rapidly lead to the perforation and septic shock.
There is gas in the lumen of the gallbladder, in the wall or in the pericholecystic space in the absence of any fistula
with the intestine.

Question 24

24. Which of the following are correct about Caroli’s disease:
    (a) Is inherited as an autosomal dominant disorder.
    (b) Is associated with autosomal dominant polycystic kidney disease.
    (c) 70-80% have extrahepatic bile duct dilatation.
    (d) Is associated with ulcerative colitis.
    (e) Cholangiocarcinoma develops in 5-10%

Answer 24

Answers:
(a) Not correct
(b) Correct
(c) Not correct
(d) Not correct
(e) Correct
Explanation:
Caroli’s disease is rare autosomal recessive disorder showing abnormal development of intrahepatic bile ducts.
The differential diagnosis includes primary sclerosing cholangitis. The ductal dilatation in primary sclerosing
cholangitis is a rarely saccular and is typically more isolated and fusiform. 70% of the patient’s with primary
sclerosing cholangitis have co-existing inflammatory bowel disease.
There are multiple intrahepatic cyst that communicate with the biliary tree with intrahepatic bile duct dilatation,
irregular bile duct walls, strictures and stones in Caroli’s

Question 25

25. Which of the following are correct about Choledochal cyst: (a) Appears as a photointense area on 1-10 min HIDA scan images. (b) Recurrent pancreatitis affects 30-40% of patients. (c) The classic triad of intermittent obstructive jaundice, recurrent colicky right upper quadrant pain and palpable mass is seen in more than 50% of patients. (d) Portal hypertension is a known complication. (e) 90% affect the intrahepatic bile ducts

Answer 25

Answers: (a) Not correct (b) Correct (c) Not correct (d) Correct (e) Not correct Explanation: Choledochal cyst is characterised by by balloon like dilatation of the extrahepatic bile ducts. It can be associated with intrahepatic bile duct dilatation in 15% of the cases. The classic triad of jaundice, recurrent colicky right upper quadrant pain and palpable mass is seen in 20-30% of the patients and bring the only images in a hilar scan shows a photopenic area. The cyst shows delayed filling which persists on delayed films. Large choledochal cysts may compresse the gallbladder leading to non-visualisation

Question 26

26. Regarding Small bowel obstruction (SBO) in adults: (a) The small bowel-faeces sign is pathognomonic of SBO. (b) Gallstone ileus typically causes jejunal obstruction. (c) Hernias are the most common cause. (d) Intussusception is associated with an underlying pathology in >75% of cases. (e) Strangulation is more common in closed loop obstruction.

Answer 26

Answers: (a) Not correct (b) Not correct (c) Not correct (d) Correct (e) Correct Explanation: Adhesions are the most common cause of small-bowel obstruction in adults followed by hernias and neoplasms. The small bowel-fecus sign has been described in the context of small-bowel obstruction but has also been also in other metabolic or infectious diseases. The most common site of stone impaction in gallstone ileus is ileum followed by jejunum and duodenum.

Question 27

27. A small bowel enema reveals smooth thickened folds in a 20cm segment of the small bowel. Differential diagnosis should include: (a) Congestive heart failure. (b) Radiation enteropathy. (c) Nephrotic syndrome. (d) Crohn’s disease. (e) Lymphoma.

Answer 27

Answers: (a) Not correct (b) Correct (c) Not correct (d) Correct (e) Correct Explanation: Generalised thickening of small bowel usually occurs in hypoproteinaemia, congestive heart failure and nephrotic syndrome. Long segment thickening may reflect intramural haemorrhage example ischaemia, anticoagulant therapy. F ocal thickening of small bowel should include lymphoma, mesenteric metastasis and early Crohn’s disease.

Question 28

28. Complications of liver transplantation: (a) Hepatic artery thrombosis occurs in less than 1% of transplant recipients (b) Portal vein thrombosis is the most common vascular complication. (c) Non-anastamotic biliary strictures carry a worse prognosis than anastamotic strictures. (d) Post-transplant lymphoproliferative disorder is frequently associated with Epstein-Barr virus infection. (e) Abscess formation is seen in 5-10%.

Answer 28

Answers: (a) Not correct (b) Not correct (c) Correct (d) Correct (e) Correct Explanation: Most common vascular complication of liver transplant includes hepatic artery thrombosis which occurs in 60% of the cases of vascular complications. It occurs within 15 days of transplantation. Portal vein thrombosis occurs in 1-2% cases of liver transplant.

Question 29

29. Which of the following are correct about Carcinoid of the appendix and small bowel: (a) 40-50 arise in the appendix. (b) The incidence of metastatic disease is directly related to primary tumour size. (c) Small-bowel carcinoids are multiple in 30-40% of patients. (d) A spiculated mesenteric mass on CT is incompatible with Carcinoid. (e) 131I-labelled MIBG uptake is specific for carcinoid.

Answer 29

Answers: (a) Correct (b) Correct (c) Correct (d) Not correct (e) Not correct Explanation: Carcinoid tumours of the gastrointestinal tract are small and often difficult to detect on routine CT scans. On CT, a carcinoid tumour appears stellate, spiculated, mesenteric mass containing calcification in the 70% of the cases. Indium labelled MIBG scan can be used for the detection of several neuroendocrine tumours like pheochromocytoma, neuroblastoma and carcinoid tumours. Octreotide is a somatostatin analogue that can also be useful for diagnosing carcinoid tumours.

Question 30

30. Which of the following are true regarding fibrolamellar hepatocellular carcinoma? (a) The majority are associated with elevated alpha fetoprotein. (b) A central scar is present in 50% of cases on ultrasonography. (c) There is delayed enhancement of the tumour following intravenous gadolinium on MRI. (d) Calcification is rarely seen on CT. (e) The central scar may enhance following intravenous contrast on CT.

Answer 30

Answers: (a) Not correct (b) Correct (c) Not correct (d) Not correct (e) Correct Explanation: Fibrolamellar carcinoma shows calcification in 40% of the cases. The tumour is unusually large, hypodense on unenhanced CT and hyperdense during the arterial phase following contrast administration. The not associated with elevated alpha-fetoprotein levels and chronic liver disease. On MRI, these tumours are heterogeneously hypointense on T1 and hyperintense on T2-weighted images.

Question 31

31. In the imaging of acute testicular torsion, which of the following are correct: (a) On sonography, a reactive hydrocoele is seen after 6 hours. (b) Surgery is successful in 20% of patients who present between 12 and 24 hours after onset of symptoms. (c) Colour Doppler ultrasound may show increased blood flow in the depididymis. (d) Hyperperfusion of the testicle on colour Doppler ultrasonography makes testicular torsion unlikely. (e) Technetium-99m pertechnetate scintigraphy typically shows a halo of hyperactivity in the acute phase (first 6 hours).

Answer 31

Answers: (a) Correct (b) Correct (c) Correct (d) Not correct (e) Not correct Explanation: Spontaneous detorsion of testis may occur leading to unilateral testicle hypoperfusion. Surgery is still indicated in these cases. Scintigraphy is highly sensitive and specific when performed only. In the acute phase, there is reduced perfusion in the testis with decreased activity. In the subacute phase, there is a peritesticular reactive hyperaemia with a hilar or increased tracer activity. Later, there is marked absence of tracer activity

Question 32

32. Which of the following are correct of cystic fibrosis? (a) Microgallbladder is a rare finding. (b) The most common abdominal MRI finding is fatty infiltration of the pancreas. (c) Pancreatic calcification is seen in 30% of patients on radiography. (d) Pancreatic cysts are a common finding. (e) Chronic liver disease is present in 75% of adults with cystic fibrosis.

Answer 32

Answers: (a) Not correct (b) Correct (c) Not correct (d) Correct (e) Not correct Explanation: Chronic liver disease is present in 25% of adults with cystic fibrosis and the severity increases with age. Pancreatic calcification is seen in 8% of the patient’s on radiography. MRI depicts the calcification poorly. Microgallbladder is a common finding. In patients with cystic fibrosis, the gallbladder is typically small, trabeculated, contracted and poorly functioning. It often contains echogenic bile, sludge and cholesterol gallstones.

Question 33

33. Which of the following are correct regarding mucosal associated lymphoid tissue (MALT) lymphoma of the gastrointestinal tract? (a) Perforation of the stomach is a recognised feature of gastric MALT lymphoma. (b) MALT lymphoma is widely disseminated at the time of diagnosis is most patients. (c) The most common site within the stomach is the antrum. (d) Ulceration is a common feature on barium study. (e) The normal stomach does not contain lymphoid follicles.

Answer 33

Answers: (a) Correct (b) Not correct (c) Correct (d) Not correct (e) Correct Explanation: MALT lymphoma shows very less dissemination and generally has a better prognosis than non-Hodgkin’s lymphoma. The most common pattern on barium study is infiltrative, either focal or diffuse. Ulcerative lesions, especially in stomach are rare.

Question 34

34. Which of the following are correct regarding imaging of liver transplantation? (a) Hepatic artery thrombosis is the most common vascular complication. (b) Portal vein thrombosis usually occurs within 24 hours of transplantation. (c) Hepatic vein stenosis is more common following living related transplants than after cadaveric transplants. (d) Biliary anastamotic stenosis are reliably diagnosed using magnetic resonance cholangiopancreatography (MRCP). (e) Periportal low attenuation on contrast-enhanced CT is a reliable sign of acute graft rejection.

Answer 34

Answers: (a) Correct (b) Not correct (c) Correct (d) Not correct (e) Not correct Explanation: Periportal low attenuation on contrast enhanced CT may be a feature of acute graft rejection, but it has poor sensitivity and specificity and is frequently seen with oedema of the periportal lymphatic vessels. Portal vein stenosis or thrombosis developsslowly, presenting with varices, splenomegaly and ascites. Portal vein stenosis may be treated by balloon dilatation, but once the thrombus is extensive and reaches the periphery of the intrahepatic portal vein branches, then a repeat liver transplant is only option.

Question 35

35. Which of the following are correct of pancreatic carcinoma? (a) The loss of a fat plane around the superior mesenteric artery is indicative of invasion. (b) CA 19-9 is elevated in more than 80% of patients with ductal adenocarcinoma. (c) Ductal adenocarcinoma has reduced signal on T1 weighted and T2 weighted MRI relative to normal pancreas. (d) Solid and papillary neoplasms are usually locally invasive at diagnosis. (e) Intraductal papillary mucinous subtypes are characterised by hyperintense pancreatic ducts on T2 weighted MRI.

Answer 35

Answers: (a) Correct (b) Correct (c) Correct (d) Not correct (e) Correct Explanation: Solid and papillary pancreatic neoplasms are large tumours that are better demarcated, thick walled and have solid and cystic areas. Imaging shows enhancement of the thick wall and lobular projections from the inner wall margins. They are more common in the body and tail of the pancreas. Calcification may be seen at the periphery.

Question 36

36. In the imaging of acute colitis, which of the following are correct? (a) Paucity of pericolonic inflammation is more suggestive of pseudomembranous colitis than ulcerative colitis. (b) Toxic megacolon is not a feature of pseudomembranous colitis. (c) In pseudomembranous colitis, the most common site involved is the rectosigmoid. (d) Portal venous gas is a more specific sign of ischaemic colitis than pneumatosis cystoides intestinalis. (e) Neutropenic colitis (typhlitic colitis) most commonly affects the descending and sigmoid colon.

Answer 36

Answers: (a) Correct (b) Not correct (c) Not correct (d) Correct (e) Not correct Explanation: CT features of pseudomembranous colitis are non-specific and include mural thickening with bowel dilatation. There is pancolitis & right-sided colitis. The rectosigmoid is spared in 67% of the cases and ascites is not uncommon. Complications include toxic megacolon on operation and peritonitis. Typhlitis is seen in neutropenia patients and usually presents as non-specific thickening of caecum and ascending colon due to necrosis.

Question 37

37. In Whipple’s disease, which of the following are correct? (a) Females are more commonly affected. (b) Sacroiliitis is a feature. (c) Ulceration is a common finding on barium studies. (d) Small bowel dilatation is a typical finding. (e) Involved lymph nodes are hypodense on CT.

Answer 37

Answers: (a) Not correct (b) Correct (c) Not correct (d) Not correct (e) Correct Explanation: Males are commonly affected (9:1 = M:F). There is absence of bowel dilatation, no ulceration and thickening of duodenum and jejunum folds due infiltration by macrophages .

Question 38

38. In recurrent cervical cancer, which of the following are correct? (a) Hydronephrosis occurs in 70% of cases. (b) Para-aortic nodes are generally involved before pelvic side-wall nodes. (c) Liver metastases occur in 30% of cases. (d) The rectum is rarely involved. (e) Adrenal gland involvement is rare.

Answer 38

Answers: (a) Correct (b) Not correct (c) Correct (d) Not correct (e) Not correct Explanation: The paracervical, parametrial, obturator and iliac nodes are involved first. Later there is spread to the common iliac and para-aortic nodes with worse prognosis. The adrenal glands is next common solid organ involvement after liver. The kidneys and pancreas are involved rarely. The recurrent tumour commonly involve the rectum and recto-vaginal fistula may develop.

Question 39

39. Which of the following are correct regarding ovarian cancer? (a) The liver is the most common site of haematogenous metastasis. (b) Serous cystadenocarcinoma contains calcification in 30% of cases on CT. (c) Mediastinal lymph node involvement is a rare finding. (d) About 75% of ovarian neoplasms are benign. (e) Lesions greater than 4cm on CT are suggestive of malignancy.

Answer 39

Answers: (a) Correct (b) Correct (c) Not correct (d) Correct (e) Correct Explanation: In the ovary cancer, lymph node spread is typically along the path of the gonadal vessels to the para-aortic nodes and along the parameterial channels to the external iliac and hypogastric group. Mediastinal nodal involvement may be seen in one third of the cases.

Question 40

40. Regarding cholangiocarcinoma, which of the following are correct? (a) Caroli’s disease is a predisposing factor. (b) The majority are squamous cell carcinomas. (c) It typically shows delayed enhancement on CT. (d) Duodenal obstruction is an early feature. (e) Tumours are low signal relative to liver on T2 weighted MRI.

Answer 40

Answers: (a) Correct (b) Not correct (c) Correct (d) Not correct (e) Not correct Explanation: Cholangiocarcinoma have varied appearance on T2-weighted imaging, from very high signal to mildly increased signal relative to liver. On T1 weighted images, and isointense to low signal relative to the liver. There is moderate enhancement after gadolinium administration. About 95% of the cholangiocarcinoma are adenocarcinoma. The tumour spreads by local invasion and may involve the portal vein and hepatic artery.

Question 41

41. Which of the following are correct regarding bladder cancers? (a) Urachal abnormalities are most frequently associated with squamous cell carcinomas. (b) MRI can identify muscle invasion. (c) The presence of low signal within the seminal vesicles on T2 weighted MRI is specific for tumour involvement. (d) Tumour extension to the cervix is common. (e) Bladder cancer enhances early following intravenous gadolinium- diethylenetriaminepentaacetic acid (DTPA).

Answer 41

Answers: (a) Not correct (b) Correct (c) Not correct (d) Not correct (e) Correct Explanation: About 90% of the bladder cancers are transitional cell tumour. Squamous cell carcinoma is associated with chronic infection and leukoplakia. Transitional cell tumour may extend to the perivesicle fat, seminal vesicles and prostate in Males but extension to the uterus and cervix is uncommon in females The seminal vesicles are high signal on T2-weighted images. Low signal changes may be seen with atrophy, tumour extension and fibrosis.