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43 Cards in this Set
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- Back
- 3rd side (hint)
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TRUE about autoimmune pancreatitis:
a. ERCP shows focal irregular ductal dilatation b. Atrophic pancreas c. Clinical symptoms mimicking acute pancreatitis (presents with pain and fever) d. Normalization of pancreatic function following treatment e. Does not respond to long term steroids |
Normalization of pancreatic function following treatment
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Typhlitis is a life-threatening, necrotizing enterocolitis occurring primarily in immunosuppressed patients. It is synonymous with "neutropenic enterocolitis" and "ileocecal syndrome." Described in children or adults with acute myeloid leukemia, multiple myeloma, myelodysplastic syndromes, aplastic anemia, acquired immunodeficiency syndrome, cyclic or drug-induced neutropenia, and after immunosuppressive therapy for solid malignancies and transplants.
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Regarding autoimmune pancreatitis, which of the following is FALSE?
(a) IgG levels are elevated (b) pancreas is diffusely enlarged (c) duct is irregularly narrowed (d) lymphocyte infiltration and fibrosis (e) peripancreatic inflammation |
peripancreatic inflammation
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MRCP is good for evaluating all of the following EXCEPT:
a. Pancreatic divisum b. CBD stones c. Choledochal cysts d. Primary biliary cirrhosis e. Hepatic ducts peripheral to obstructing stone/lesion |
PBC
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PBC affects tiny intrahepatic ducts we cannot see.
MRCP Indications: 1) Screening for low to intermediate probability of bile duct stones (95 -100% accuracy). Particularly, patients with suspected gallstone pancreatitis and in patients with non-specific abdominal pain and normal liver enzymes. Normal MRCP can prevent an unnecessary diagnostic ERCP. 2) Failed or incomplete ERCP or for patients who are not ERCP candidates due to conditions (e.g., surgical diversion of biliary tree). 3) Variant ductal anatomy. 4) Primary sclerosing cholangitis - MRCP can show ductal irregularities, strictures and stones, and avoids the risk of ERCP-induced sepsis. 5) Complications of chronic pancreatitis. MRCP can demonstrate ductal dilatation, strictures, intraductal stones, fistulas and pseudocysts and can serve as a planning tool prior to surgical drainage procedures. |
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Status post liver transplant with new biliary dilatation. Need to evaluate:
a. Hepatic artery patency b. Portal vein patency c. Cholangiocarcinoma d. Hepatic vein patency |
Hepatic artery patency
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Hepatic artery supplies biliary ducts. This is one of worst complications after transplant. Nonanastomotic (intrahepatic) stricture is caused by heaptic arterial thrombosis/stenosis in 50%. Hepatic artery thrombosis (HAT) is the leading cause of graft loss and retransplantation (4-26%). CECT of hepatic artery thrombosis or stenosis will show peripheral wedge-shaped low attenuation regions, unopacified hepatic artery, biloma or intrahepatic biliary dilation due to biliary strictures
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Most common finding of H. pylori gastritis?
a. Thickened rugal folds b. Erosions c. Antral striations |
thickened rugal folds
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Specific finding of Barrett’s esophagus:
a. Reticular mucosal pattern b. Reflux esophagitis c. Ulcers d. Hiatal hernia e. Peptic (esophageal) stricture |
reticular mucosal pattern
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Reticular mucosal pattern is a specific sign (distal to stricture): innumerable, tiny, barium-filled mucosal grooves/crevices, usually seen adjacent to distal aspect of esophageal stricture; this finding is seen in only 5-30% of patients. The best diagnostic clue, however, is a mid-esophageal stricture with hiatal hernia & reflux which is pathognomonic. "A reticular mucosal pattern, which may be discontinuous in the distal esophagus (short segment), is the most sensitive finding."
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MR appearance of pancreatic islet cell:
a. Hyperintense on T1, hypovascular b. Hyperintense on T2, hypervascular (enhancement post-gad) c. Hyperintense on T1, hypovascular |
Answer: Hyperintense on T2, hypervascular(enhancement post-gad)
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MR imaging of the majority of insulinomas and most gastrinomas reveals T1 and T2 prolongation. Insulinomas may be hypointense or only slightly hyperintense on T2-weighted images if they contain a substantial amount of collagen at histologic analysis. Insulinomas enhance intensely after administration of gadolinium contrast material. The normal pancreas enhances less than the hypervascular tumor. The enhancement pattern is most commonly homogeneous.
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TRUE of pancreatic islet cell tumor:
a. Most are multiple b. Most are nonfunctional c. Most are in pancreatic head d. Majority metastasize e. Intraoperative ultrasound is highly effective to detect functional lesions (versus Intraoperative US is effective at locating malignant tumors) f. Gastrinoma is the most common |
IntraOP USis helpful for localization
OR Majority metastisize |
60-90% with metastasis to the liver+/- regional lymph nodes at presentation. Intraoperative US is a valuable technique for localizing small lesions. It has a greater sensitivity for intrapancreatic lesions than for extrapancreatic lesions and is therefore more helpful for localization of insulinoma than for gastrinoma. The overall sensitivity of intraoperative US ranges between 75-100%, and the technique is more sensitive than all other preoperative imaging.
Most are solitary. 85% are functional. Not mostly in the pancreatic head. Insulinoma (no. 1 most common) single benign in 80-90%. No specific location in pancreas. Only 2-5% ectopic. Associated with MEN 1. 75-100% endo+intraop US sensitivity. Gastrinoma (no. 2 most common) only 87% in pancreas. Ectopic 7-33%. 50% solitary in head/tail. 50% multiple. 50-60% malignant with mets. Assoc with MEN 1. Nonfunctioning (no. 3 most common) predominantly in panc head. 80-100% malignant with mets. Dx with CT, not US. Somatostatinoma- predom in panc head. 50-90% malignant, mets in 70%. VIPoma- predom body/tail, can be ectopic. 50-80% malignant. |
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30 yo chemotherapy pt w/ neutropenic colitis. Which is LEAST likely involved?
a. Terminal ileum b. Cecum c. Ascending colon d. Transverse colon |
Transverse colon
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TRUE about autoimmune pancreatitis:
a. ERCP shows focal irregular ductal dilatation b. Atrophic pancreas c. Clinical symptoms mimicking acute pancreatitis (presents with pain and fever) d. Normalization of pancreatic function following treatment e. Does not respond to long term steroids |
Normalization of pancreatic function following treatment
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ERCP can show diffuse irregular narrowing of main pancreatic duct (not dilatation).
The pancreas is diffusely or at least focally enlarged on CT and shows diffuse delayed enhancement. Capsule-like low density rim surrounding the pancreas. It is a subtype or subset of chronic pancreatitis. Minimal or no peripancreatic inflammation. No vascular encasement. Absence of acute attacks of pancreatitis. Pathologically, lymphoplasmacytic proliferation along with fibrosis. Elevation of serum gamma globulin and IgG; autoantibodies to pancreatic antigens. Steroids are effective at reversing both the morphological and functional pancreatic abnormalities. |
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Regarding autoimmune pancreatitis, which of the following is FALSE?
(a) IgG levels are elevated (b) pancreas is diffusely enlarged (c) duct is irregularly narrowed (d) lymphocyte infiltration and fibrosis (e) peripancreatic inflammation |
peripancreatic inflammation
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MRCP is good for evaluating all of the following EXCEPT:
a. Pancreatic divisum b. CBD stones c. Choledochal cysts d. Primary biliary cirrhosis e. Hepatic ducts peripheral to obstructing stone/lesion |
PBC
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30 yo chemotherapy pt w/ neutropenic colitis. Which is LEAST likely involved?
a. Terminal ileum b. Cecum c. Ascending colon d. Transverse colon |
Transverse colon
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TRUE about autoimmune pancreatitis:
a. ERCP shows focal irregular ductal dilatation b. Atrophic pancreas c. Clinical symptoms mimicking acute pancreatitis (presents with pain and fever) d. Normalization of pancreatic function following treatment e. Does not respond to long term steroids |
Normalization of pancreatic function following treatment
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ERCP can show diffuse irregular narrowing of main pancreatic duct (not dilatation).
The pancreas is diffusely or at least focally enlarged on CT and shows diffuse delayed enhancement. Capsule-like low density rim surrounding the pancreas. It is a subtype or subset of chronic pancreatitis. Minimal or no peripancreatic inflammation. No vascular encasement. Absence of acute attacks of pancreatitis. Pathologically, lymphoplasmacytic proliferation along with fibrosis. Elevation of serum gamma globulin and IgG; autoantibodies to pancreatic antigens. Steroids are effective at reversing both the morphological and functional pancreatic abnormalities. |
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Specific finding of Barrett’s esophagus:
a. Reticular mucosal pattern b. Reflux esophagitis c. Ulcers d. Hiatal hernia e. Peptic (esophageal) stricture |
Reticular mucosal pattern
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Regarding autoimmune pancreatitis, which of the following is FALSE?
(a) IgG levels are elevated (b) pancreas is diffusely enlarged (c) duct is irregularly narrowed (d) lymphocyte infiltration and fibrosis (e) peripancreatic inflammation |
peripancreatic inflammation
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Most common tumor with aneurysmal dilatation of the small bowel:
a. Melanoma met b. Adenocarcinoma c. Non-Hodgkin's lymphoma d. Hodgkin's lymphoma e. Carcinoid |
NHL
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TRUE of pancreatic islet cell tumor:
(a) hypovascular liver mets (b) associated with VHL (c) insulinoma usually metastatic (d) non-functioning tumors rarely metastasize (e) glucagonoma second most common |
VHL
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MRCP is good for evaluating all of the following EXCEPT:
a. Pancreatic divisum b. CBD stones c. Choledochal cysts d. Primary biliary cirrhosis e. Hepatic ducts peripheral to obstructing stone/lesion |
PBC
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Specific finding of Barrett’s esophagus:
a. Reticular mucosal pattern b. Reflux esophagitis c. Ulcers d. Hiatal hernia e. Peptic (esophageal) stricture |
Reticular mucosal pattern
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Most common tumor with aneurysmal dilatation of the small bowel:
a. Melanoma met b. Adenocarcinoma c. Non-Hodgkin's lymphoma d. Hodgkin's lymphoma e. Carcinoid |
NHL
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TRUE of pancreatic islet cell tumor:
(a) hypovascular liver mets (b) associated with VHL (c) insulinoma usually metastatic (d) non-functioning tumors rarely metastasize (e) glucagonoma second most common |
VHL
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TRUE of pancreatic islet cell tumors:
a. Most insulinomas are malignant b. Glucagonomas are most common type c. Non-functioning tumors are the most likely to present with disease that has already progressed d. Increased incidence with VHL |
Answer: Non-functioning tumors are the most likely to present with disease that has already progressed
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TRUE regarding omental infarct:
a. Most commonly present with RUQ pain b. Presents with nausea and vomiting c. More common in thin patients d. Surgical treatment is necessary e. Adhesions are the most common cause |
Most commonly presents with RLQ pain (sometimes RUQ pain)
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TRUE of pancreatic islet cell tumors:
a. Most insulinomas are malignant b. Glucagonomas are most common type c. Non-functioning tumors are the most likely to present with disease that has already progressed d. Increased incidence with VHL |
Answer: Non-functioning tumors are the most likely to present with disease that has already progressed
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TRUE regarding omental infarct:
a. Most commonly present with RUQ pain b. Presents with nausea and vomiting c. More common in thin patients d. Surgical treatment is necessary e. Adhesions are the most common cause |
Most commonly presents with RLQ pain (sometimes RUQ pain)
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Man with extensive abdominal (pancreatic) calcifications on KUB and now presents with a smooth lobulated mass near medial gastric fundus:
a. Gastric varices b. Leiomyoma c. Fistulization with pancreas d. Gastric adenocarcinoma e. GIST |
Fistulization with pancreas (psuedocyst)
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Most common cause of pseudocirrhosis (mimics cirrhosis) on CT?
a. Treated breast cancer b. Metastatic colon cancer c. liver transplant rejection d. pyogenic abscess e. candidiasis f. primary sclerosing cholangitis |
Tx breast CA (or lung)
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Man with extensive abdominal (pancreatic) calcifications on KUB and now presents with a smooth lobulated mass near medial gastric fundus:
a. Gastric varices b. Leiomyoma c. Fistulization with pancreas d. Gastric adenocarcinoma e. GIST |
Fistulization with pancreas (psuedocyst)
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LEAST likely liver lesion to demonstrate increased through transmission?
a Metastasis b Focal fatty infiltration c HCC d Hemangioma e Abscess |
Focal Fat
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Most common cause of pseudocirrhosis (mimics cirrhosis) on CT?
a. Treated breast cancer b. Metastatic colon cancer c. liver transplant rejection d. pyogenic abscess e. candidiasis f. primary sclerosing cholangitis |
Tx breast CA (or lung)
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MRI finding most specific for HCC:
a. early enhancement with delayed central washout b. array of T1 and T2 findings c. fat within the lesion (per UF) |
Fat within lesion
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Answer: Fat within the lesion
When you see fat in a liver mass, think of HCC as number one, because it’s so common. If the patient is a young woman, keep in mind that adenomas can also have macroscopic fat. HCC varies on MR depending on factors such as hemorrhage, degree of fibrosis, histologic pattern, degree of necrosis, and amount of fatty change. T1WI: isointense, hypointense, or hyperintense relative to the liver. T2WI: usually hyperintense (if the mass is bright on T2-weighted images, it is HCC until proven otherwise). Post-contrast: early enhancement and usually early washout, sometimes demonstrating delayed capsular enhancement. Delayed central washout is not a feature of HCC. In addition, a "flash filling" hemangioma can have rapid arterial enhancement but could be differentiated by lack of washout on delayed images. |
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LEAST likely liver lesion to demonstrate increased through transmission?
a Metastasis b Focal fatty infiltration c HCC d Hemangioma e Abscess |
Focal Fat
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In a patient with glycogen storage disease, what are you likely to see in the liver?
a. hepatic cysts b. regenerative nodules c. hepatic adenomas d. FNH |
Hepatic adenomas
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MRI finding most specific for HCC:
a. early enhancement with delayed central washout b. array of T1 and T2 findings c. fat within the lesion (per UF) |
Fat within lesion
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Answer: Fat within the lesion
When you see fat in a liver mass, think of HCC as number one, because it’s so common. If the patient is a young woman, keep in mind that adenomas can also have macroscopic fat. HCC varies on MR depending on factors such as hemorrhage, degree of fibrosis, histologic pattern, degree of necrosis, and amount of fatty change. T1WI: isointense, hypointense, or hyperintense relative to the liver. T2WI: usually hyperintense (if the mass is bright on T2-weighted images, it is HCC until proven otherwise). Post-contrast: early enhancement and usually early washout, sometimes demonstrating delayed capsular enhancement. Delayed central washout is not a feature of HCC. In addition, a "flash filling" hemangioma can have rapid arterial enhancement but could be differentiated by lack of washout on delayed images. |
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In a patient with glycogen storage disease, what are you likely to see in the liver?
a. hepatic cysts b. regenerative nodules c. hepatic adenomas d. FNH |
Hepatic adenomas
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Which of the following is NOT associated with intestinal malrotation?
A. gastroschisis. B. omphalocele C. situs inversus totalis D. congenital diaphragmatic hernia E. asplenia |
Situs inversus totalis
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Which of the following is NOT associated with intestinal malrotation?
A. gastroschisis. B. omphalocele C. situs inversus totalis D. congenital diaphragmatic hernia E. asplenia |
Situs inversus totalis
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A female patient has polycythemia rubra vera and suffers acute onset of right upper quadrant pain, hepatomegaly, and ascites. Liver biopsy demonstrates hepatic necrosis. What is the etiology?
a. Budd-chiari syndrome b. autoimmune hepatitis |
autoimmune hepatitis
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FALSE about familial adenomatous polyposis coli (FAP)?
a. Associated with gastric adenomatous polyps in 80% b. Occurs with abdominal desmoid tumors c. Associated with cancer of duodenal papilla (ampullary tumor) d. Autosomal dominant e. 100% colon CA is left untreated |
Associated with gastric adenomatous polyps in 80% (FALSE)
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Increased risk of all of the following with hereditary non-polyposis colorectal cancer syndrome EXCEPT:
(a) cholangiocarcinoma (b) endometrial cancer (c) breast cancer (d) ovarian cancer (e) gastric cancer |
Breast
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What mesentery attaches to the anterior surface of the pancreas?
a. lesser omentum b. gastocolic ligament c. transverse mesocolon d. faliform ligment e. greater omentum f. lesser omentum |
transverse mesocolon
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What is a characteristic on IPMT on CT?
a) diffuse pancreatic ductal dilatation b) unilocular mass c) multilocular mass d) hypodense mass |
Answer: Diffuse pancreatic ductal dilatation
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