Multiple Choice Questions

GI Radiology

Name: Date: 25/08/2019

1. The first Line investigation of Upper GI bleeding is

a. CT Angiography c. ENDOSCOPY
b. DSA d. Radio-nucleotide study

2. The most sensitive imaging study for localization of GI bleeding

a. CT angiography c. DSA
b. Radionuclide scanning d. Barium study

3. Best Treatment option for massive lower GI bleeding is

a. Endoscopy and management
b. Conservative
c. Angiography and embolization
d. Surgical

4. Which of the following is false

a. Water soluble contrast should be used if a leak or perforation are
suspected.
b. A double contrast upper GI series uses both oral and IV contrast.
c. A double contrast study provides improved mucosal vizualization.
d. The imaging study of choice for diagnosing hypertrophic pyloric stenosis
is ultrasonography

5. Carmen Meniscus Sign is seen in

a. Single contrast barium study in malignant ulcer
b. Double contrast barium study in benign ulcer
c. CT scan with contrast in Malignant Gastric ulcer
d. CT scan with oral contrast in gastric ulcer

6. Which of the following findings will be more consistent with Crohn’s disease that
ulcerative colitis.
a. Apthous ulceration interspersed with normal mucosal area
b. Fine granular appearance of descending and sigmoid colon
c. Isolated involvement of sigmoid and rectum
d. Presence of collar button ulcer

7. Which of the following is not a sign of pneumoperitoneum

a. Football sign c. Rigler’s sign
b. String of pearl sign d. Telltale Triangle sign

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8. Which of the following will most likely represent toxic megacolon in plain
radiograph
a. Caecum more than 6 cm in diameter
b. Multiple mucosal island in dilated transverse colon (more than 6 cm)
c. Pseudo diverticulum in descending colon
d. Thickened Haustrathrough out entire colon
e. Thumb printing in transverse colon

9. A 82 years old female is referred to emergency with 48 hrs. history of generalized

abdominal pain and vomiting. On examination, she is dehydrated and tachycardic.
Abdominal radiograph demonstrated multiple dilated small bowel loops largest
measuring 4.5 cm in diameter. A linear gas filled structure with short branching is
also noted in right upper quadrant. What is the most likely diagnosis?
a. Acute intestinal ischemia
b. Emphysematous cholecystitis
c. Gall stone ileus
d. Obstructed right inguinal hernia
e. Small bowel obstruction due to adhesion.

10. A 17 years old male has history of intermittent lower GI bleeding. Colonoscopy
was unremarkable. A Tc-99 pertechnitate study revealed activity in lower
abdomen. 2 months later the patient presented to the emergency with pain
abdomen and vomiting. A CT scan demonstrated ileo-colic intussusception. What
is the likely cause?
a. Mesenteric lymphadenopathy
b. Ileal lipoma
c. Meckel’s Diverticulum
d. Small bowel adenocarcinoma

11. A 19 yrs old female presents with pain abdomen and low-grade fever. On
examination there is mild tenderness in right iliac fossa. A graded compression
Ultrasound of the abdomen is performed. Which of the following is true.
a. A transverse appendicular diameter of 5 mm is diagnostic of acute
appendicitis
b. Presence of pelvic fluid makes diagnosis of acute appendicitis unlikely
c. Non visualization of dilated appendix rules out acute appendicitis.
d. Hyperechoic fat and fluid collection may be seen in companion to dilated
appendix in acute appendicitis.

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12. A 17 year old presents to the ER with pain abdomen and vomiting. On
examination the patient has hyperpigmented macules on lips, palms and soles. CT
scan shows multiple GI polyps and mass in jejunum with ileocolic
intussusception. A endoscopy evaluation also demonstrated multiple polyps in
stomach and duodenum. Which is False?
a. The patient most likely has PeutzJegher’s syndrome.
b. The polyps in PeutzJegher’s syndrome are villous adenomas.
c. The polyps in PeutzZegher’s syndrome do not shows malignant
transformation.
d. There is risk of recurrent intussusception in PJS.

13. A 29 years old man presents with dysphagia more for liquid than solid food. On
barium swallow examination there is retained food in the stomach with smooth
narrowing at distal esophagus with barium intermittently spurting into the
esophagus. What is the most likely diagnosis
a. Achalasia cardia c. Pseudo achalasia
b. Esophageal leiomyoma d. Para esophageal hernia

14. Which finding will make ulcer more likely benign than malignant?
a. Hampton’s line
b. Ulcer doesnot extend beyond the gastric wall
c. Carmen meniscus sign
d. Kirklin Meniscus complex

15. Which of the following is makes caecal volvulus more likely than Sigmoid
volvulus?
a. Presence of hautral marking on dilated viscus
b. The tip of the dilated loop above T10
c. Tip of Dilated viscus on left upper quadrant
d. High Fiber diet

16. A 23 year old female presented with history of diarrhea and rectal bleeding. Her
father died of colorectal carcinoma. A barium enema examination demonstrated
more than 100 polyps less than 5 mm through out the colon. What is the likely
diagnosis?
a. As PeutzJegher Syndrome
b. Familial adenomatous polyposis syndrome
c. Carcinoid syndrome
d. Juvenile polyposis syndrome

17. Which one of the following is not a differential diagnosis for diffuse small bowel
wall thickening?
a. Acute mesenteric c. Cirrhosis of Liver
ischemia d. Adenocarcinoma of small
b. Hypoalbuminemia bowel

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18. Which of the following does not differentiate between small and large bowel
obstruction?
a. Central versus peripheral location
b. Bowel wall thickness of 3 mm in small bowel versus 5 mm in large bowel
c. Concentric circumferential valvulaeconniventis in small bowel versus non
concentric partial hautrae of large bowel
d. All of above help to differentiate

19. Which of the following helps to differentiate crohn’s disease versus tuberculosis
a. Involvement of terminal ileum only in tuberculosis
b. Stricture in distal ileum seen only in crohn’s disease
c. Contiguous involvement of caecum with deformed and high caecum in
tuberculosis
d. Fistula is seen only in Crohn’s disease

20. A 30 yrs old patient with AIDS with CD4 count less than 200 presents with
dysphagia. A barium swallow examination demonstrates multiple plaques with ill-
defined fluffy appearance of the esophagus. What is the most likely diagnosis?
a. Achalasia Cardia c. Candida esophagitis
b. Nut Craker esophagus d. Corrosive stricture

21. A feline esophagus is seen in

a. A Normal patients c. Cat Scratch Disease
b. Infectious esophagitis d. Motility disorder

22. Which of the following is false

a. Omphalocele is covered with membrane
b. Visualization of free floating bowel loops in amniotic cavity on ultrasound
is diagnostic of Gastroschisis
c. The herniation of liver into the umbilicus cord at 9 -11weeks is
physiological
d. Omphalocele are associated with chromosomal abnormalities

23. A 1 month old male child presents with vomiting after every feed, A Ultrasound
of the abdomen was advised which demonstrated features of infantile
hypertrophic pyloric stenosis. Which one of the following is true
a. Elongated pylorus more than 12 mm is a finding of hypertrophic pyloric
stenosis
b. Normal thickness of pyloric muscle is upto 5mm
c. A thickened pylorus excludes the diagnosis of hypertrophic pyloric
stenosis
d. Demonstration of peristalsis and opening of pylorus doesnot rule out
diagnosis of hypertrophic pyloric stenosis.

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24. One of the following is a sign of intestinal obstruction
a. Football sign c. Telltale triangle sign
b. Falciform ligament sign d. String of bead sign

25. A 43 year old male presents with chronic abdominal pain, loss of appetite and
weight loss. He has altered bowel habits. A barium follow through examination
revealed deformed pulled up caecum with circumferential narrowing of the
terminal ileum and multiple concentric stricture in terminal ileum. Which of the
following is true?
a. Tuberculosis can be ruled out by a normal chest x-ray and negative
sputum study
b. Hyper vascular mesentery (comb’s sign) is not in favor of diagnosis of
intestinal tuberculosis
c. Enlarged necrotic lymph nodes must be present to diagnose a patient as
intestinal tuberculosis
d. Pericaecal fat stranding is not in favor of the diagnosis of intestinal
tuberculosis

26. A patient with abdominal pain and vomiting. Clinical examination revealed
hyperactive bowel sounds and diffuse tenderness, but no sign of peritonitis. A
plain film of abdomen demonstrated dilated bowel loops with multiple air fluid
level in central part of abdomen with circumferential regular folds. What is likely
diagnosis?
a. Paralytic ileus c. Small bowel obstruction
b. Large bowel obstruction d. Gastric volvulus

27. Which of the following is not a sign of bowel obstruction?

a. Dilated bowel loops c. Gasless bowel
b. String of beads sign d. Sentinel loop sign

28. A double bubble sign is seen in

a. Pyloric stenosis c. Anal atresia
b. Duodenal atresia d. Duplication of stomach

29. One of the following findings favors lymphoma than carcinoma stomach.
a. Focal mural thickening of antropyloric region
b. Non compliant stenosis of the antropyloric region with wall thickening
c. Transpyloric spread of tumor to duodenum
d. Enlarged lymphnode in perigastric region and along celiac axis

30. Which is the best modality to locally stage rectal carcinoma

a. Digital rectal examination c. CT scan
b. Transrectal ultrasound d. MRI

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Answer Keys (GI Tract)

1. Ans- c
2. Ans- b
3. Ans- c
4. Ans- b
5. Ans- a
6. Ans-a
7. Ans -b
8. Ans- b
9. Ans- c
10. Ans- c
11. Ans- d
12. Ans- b
13. Ans- a
14. Ans- a
15. Ans- a
16. Ans- b
17. Ans- d
18. Ans- b
19. Ans- c
20. Ans -c
21. Ans -a
22. Ans- c
23. Ans-a
24. Ans d
25. Ans - b
26. Ans- c
27. Ans- d
28. Ans- b
29. Ans- c
30. Ans- d