Gastrointestinal Tract
The small intestine is a region of the GI tract extending from the: a. duodenum to the ileum b. pyloric opening to the appendix c. duodenum to the cecum d. duodenum to the appendix e pyloric opening to the ileocecal valve
e pyloric opening to the ileocecal valve
McBurney point is best described as a point between the: a. umbilicus and inguinal canal b. symphysis pubis and right iliac crest c. umbilicus and right iliac crest d. xiphoid and right costal margin e. right costal margin and right iliac crest
c. umbilicus and right iliac crest
The right margin of the esophagus is contiguous with the: a. duodenum b. pyloric canal c. tail of the pancreas d. lesser curvature of the stomach e. greater curvature of the stomach
d. lesser curvature of the stomach
The wall in an adult appendix is considered abnormal once the thickness exceeds: a. 2 mm b. 4 mm c. 6 mm d. 8 mm e. 10 mm
a. 2 mm
What is the transducer of choice for evaluation of acute appendicitis? a. 5 MHz linear array with short focus b. 5 MHz curved linear array with long focus c. 3.5 MHz curved linear array d. 3.5 MHz phased array e. 2.25 MHz phased array
a. 5 MHz linear array with short focus
For better sonographic visualization of the pyloric sphincter, the infant is often placed in what position? a. RLD b. LLD c. prone d. upright
a. RLD
Which of the following structures demonstrates haustral wall markings? a. cecum b. appendix c. duodenum d. stomach e. ascending colon
e. ascending colon
Which of the following sections of the GI tract terminates at the junction with the sigmoid colon? a. cecum b. rectum c. ileum d. transverse colon e. descending colon
e. descending colon
What is the most common malignant tumor of the GI tract? a. adenocarcinoma b. mesenchymal tumors c. lymphoma d. metastatic tumors e. cystadenocarcinoma
a. adenocarcinoma
What is the innermost lining of the gut? a. mucosa b. submucosa c. muscularis propria d. serosa e. adventitia
a. mucosa
Clinical findings of a patient with crohn's disease include all of the following except: a. palpable abdominal mass b. rectal bleeding c. abdominal pain d. weight loss
a. palpable abdominal mass
Which of the following is not a layer of gut identified with sonography? a. visceral b. serosa c. submucosal d. mucosa
a. visceral
The large intestines include all of the following regions except the: a. rectum b. ileum c. cecum d. appendix e. sigmoid
b. ileum
During sonographic evaluation of the appendix, you detect an appendicolith. What is the sonographic appearance of this structure? a. hyperechoic focus with posterior shadowing b. hyperechoic focus with posterior acoustic enhancement c. hypoechoic focus with posterior acoustic enhancement d. hypoechoic focus with posterior shadowing e. punctate focus without shadowing
a. hyperechoic focus with posterior shadowing
What are the diagnostic criteria for pyloric stenosis? a. 17 mm in thickness and 2 mm in length b. 17 mm in thickness and 3 mm in length c. 3 mm in thickness and 10 mm in length d. 3 mm in thickness and 17 mm in length
d. 3 mm in thickness and 17 mm in length
To be considered within normal limits, the wall thickness of the pyloric canal should not exceed: a. 2 mm b. 4 mm c. 6 mm d. 8 mm e. 10 mm
b. 4 mm
You are performing an ultrasound study to rule out the presence of acute appendicitis. Which of the following constitutes an abnormal finding? a. appendix diameter greater than or equal to 6 mm b. noncompressible appendix c. appendix diameter greater than or equal to 3 mm d. a and b only e. b and c only
d. a and b only
You are imaging a patient with dilated loops of bowel. You detect the presence of haustra. This is an identifying feature of which part of the GI tract? a. stomach b. duodenum c. small intestine d. colon e. all of the above
d. colon
The area of pain and rebound tenderness with acute appendicitis is most likely at: a. meckel point b. McBurney point c. Murphy point d. olive point
b. McBurney point
The esophagus begins at the pharynx and terminates into the: a. esophageal orifice of the stomach b. cardiac orifice of the stomach c. pyloric orifice of the stomach d. gastric orifice of the stomach e. esophageal hiatus of the stomach
b. cardiac orifice of the stomach
All of the following are sonographic findings of acute appendicitis except: a. appendicolith b. compressible, blind-ended tube c. periappendiceal fluid collection d. hyperemic flow
b. compressible, blind-ended tube
The common bile duct enters which of the following sections of the duodenum? a. superior b. descending c. ascending d. inferior e. horizontal
b. descending
Malignant neoplasms involving the large intestines are most frequently located in which of the following regions? a. ileum b. rectum c. sigmoid d. ascending colon e. descending colon
b. rectum
Extreme pain over McBurney point is most commonly associated with: a. cholecystitis b. intussusception c. an appendicitis d. diverticulitis e. pancreatitis
c. an appendicitis
The olive sign is best described as: a. the palpation of the inflamed appendix with rebound tenderness b. an area of pain halfway between the anterior superior iliac spine and the umbilicus c. an enlarged palpable pyloric sphincter d. the sonographic appearance of pyloric stenosis
c. an enlarged palpable pyloric sphincter
A gastric ulcer is most commonly caused by a(n): a. neoplasm b. increase in gastrin c. bacterial infection d. decrease in hydrochloric acid e. decrease in sodium bicarbonate
c. bacterial infection
An episode of excessive alcohol consumption is most commonly associated with which of the following conditions? a. ileus b. colitis c. gastritis d. appendicitis e. diverticulitis
c. gastritis
Clinical symptoms related to an episode of acute appendicitis may include all of the following except: a. fever b. nausea c. heartburn d. positive McBurney sign e. periumbilical pain
c. heartburn
Which of the following organs is considered the principal organ of digestion? a. mouth b. pharynx c. esophagus d. stomach e. small intestines
d. stomach
Which of the following is not a sonographic finding consistent with crohn's disease? a. bowel wall thickening b. noncompressible bowel that has a target appearance c. increased peristalsis d. hyperemic wall
c. increased peristalsis
The telescoping of one segment of bowel into another is referred to as: a. volvulus b. crohn disease c. intussusception d. pyloric stenosis
c. intussusception
Possible sonographic findings in gastric carcinoma include all of the following except: a. target lesion b. gastric wall thickening c. large cystic mass d. hypervascular mass e. left upper quadrant mass
c. large cystic mass
You have been asked to evaluate a suspicious gut mass with color and spectral Doppler. What is the role of Doppler in evaluation of gut masses? a. color Doppler is definitive in determination if a mass is benign or malignant b. color Doppler is used to identify regions of peristalsis c. color Doppler is useful to identify the layers of the gut d. color Doppler aids in differentiation between ischemic and inflammatory gut masses e. there is no role for color or spectral Doppler in the evaluation of the GI tract
d. color Doppler aids in differentiation between ischemic and inflammatory gut masses
Which of the following is not a section of the duodenum? a. ascending b. descending c. superior d. inferior e. horizontal
d. inferior
Ulcers are more commonly located in which of the following regions of the stomach? a. body b. fundus c. pylorus d. lesser curvature e. greater curvature
d. lesser curvature
The situation when bowel protrudes into a weakened area in the lower 1/4 of the rectus muscle is referred to as: a. inguinal hernia b. linea alba hernia c. umbicial hernia d. spigelian hernia
d. spigelian hernia
Rebound tenderness is associated with: a. appendicitis b. intussusception c. diverticulitis d. gastric carcinoma
a. appendicitis
The orifice of the appendix opens into which of the following? a. cecum b. descending colon c. jejunum d. ileum e. sigmoid
a. cecum
You are imaging a thickened loop of bowel in a patient with crohn's disease and detect a hyperechoic "mass effect" adjacent to the bowel with a thyroid like appearance. This finding is most consistent with which of the following? a. creeping fat b. fistula c. stricture d. appendicitis e. adenocarcinoma
a. creeping fat
An autoimmune disease characterized by periods of inflammation of the gastrointestinal tract describes: a. crohn disease b. intussusception c. pyloric stenosis d. meckel diverticulitis
a. crohn disease
A patient presents with a history of abdominal distension and pain. A sonogram of the periumbilical area demonstrates distended fluid filled loops of small bowel. On the basis of the clinical history, the sonographic findings are most suspicious for which of the following conditions? a. ileus b. intussusception c. diverticulitis d. crohn disease e. acute appendicitis
a. ileus
The situation when bowel protrudes into the groin is referred to as: a. inguinal hernia b. linea alba hernia c. umbicial hernia d. spigelian hernia
a. inguinal hernia
The most common cause of intestinal obstruction in children less than 2 years of age is: a. intussusception b. midgut malrotation c. pyloric stenosis d. acute appendicitis
a. intussusception
All of the following are true of normal intestinal findings with sonography except: a. normal bowel does not compress b. normal bowel should have observable peristalsis c. intestinal wall should measure less than 5 mm d. normal bowel has little to no color Doppler signals
a. normal bowel does not compress
An asymptomatic patient demonstrates a small, intraluminal hypoechoic mass on ultrasound. The mass appears to protrude from a gastric wall. This is most suspicious for which of the following gastric pathologies? a. polyp b. ulcer c. adenoma d. leiomyoma e. leiomyosarcoma
a. polyp
Which of the following abnormalities is not associated with a mucocele? a. polyp b. neoplasm c. fecalith d. gastritis e. scarring
a. polyp
You are performing an abdominal ultrasound on a patient with a history of Crohn's disease. What part of the GI tract is most commonly involved with this disorder? a. terminal ileum and colon b. colon and antrum of the stomach c. duodenum d. pyloris and lesser curve of the stomach e. Crohn's disease affects the entire GI tract equally
a. terminal ileum and colon
All of the following are sonographic criteria in the diagnosis of pyloric stenosis except: a. wall of the pylorus measures less than 8 mm b. length of the pylorus measures more than 17 mm c. doughnut appearance in transverse d. cervix appearance in longitudinal
a. wall of the pylorus measures less than 8 mm
Hypertrophic pyloric stenosis is most often found in infants between: a. 1 and 10 days of age b. 2 and 8 weeks of age c. 10 and 24 weeks of age d. 2 and 4 years of age
b. 2 and 8 weeks of age
Gastric cancer is most often in the form of: a. cystadenocarcinoma b. adenocarcinoma c. rhabdomyocarcinma d. angiosarcoma
b. adenocarcinoma
You are imaging the RLQ in a patient with leukocytosis and a low-grade fever. What part of the GI tract will you most likely see in this area? a. sigmoid b. cecum c. descending colon d. duodenum e. pylorus
b. cecum
ou are imaging a 25-year-old female with a history of chronic diarrhea, weight loss, abdominal pain and fever. You detect a segment of concentrically thickened small bowel that is hyperemic by color Doppler. This finding is most consistent with which of the following? a. adenocarcinoma b. crohn's disease c. acute appendicitis d. acute diverticulitis e. lymphoma
b. crohn's disease
Which part of the GI tract curves around the pancreatic head? a. hepatic flexure of the colon b. duodenum c. jejunum d. pyloris e. ileum
b. duodenum
All of the following are common clinical findings in infants that present with intussusception except: a. vomiting b. first-born male infant c. red currant jelly stools d. leukocytosis
b. first-born male infant
Which of the following best describes the location of McBurney point? a. left lateral to the umbilicus and medial to the left iliac crest b. halfway between the anterior superior iliac spine and the umbilicus c. midway between the umbilicus and symphysis pubis d. medial to the superior iliac spine
b. halfway between the anterior superior iliac spine and the umbilicus
During abdominal sonography, you detect a fluid filled mass in the left upper quadrant. What technique below is most useful in determining if this mass is the stomach or a pathologic structure? a. have the patient perform a valsalva manuever b. have the patient drink some water while imaging the suspicious area c. scan the patient in both inspiration and expiration d. roll the patient into a LLD position and rescan e. evaluate the area with color Doppler
b. have the patient drink some water while imaging the suspicious area
Which of the following is not associated with a rectus sheath hematoma? a. palpable abdominal mass b. increased hematocrit c. child birth d. sneezing
b. increased hematocrit
You have detected dilated bowel with multiple concentric rings within it in a patient with severe abdominal pain. This finding is most consistent with which of the following? a. crohn's disease b. intussusception c. adenocarcinoma d. lymphoma e. acute diverticulitis
b. intussusception
A female patient complaining of right lower quadrant pain and vomiting presents to the ER. Her last menstrual period was 2 weeks earlier. A pelvic ultrasound might be ordered to rule out all of the following except: a. appendicitis b. pancreatitis c. ovarian torsion d. hemorrhagic cyst e. tubo-ovarian abscess
b. pancreatitis
During abdominal sonography of a 68-year-old male, you suspect an exophytic mass arising from the stomach. Which technique qill be most useful in analysis of this mass? a. scan the area while the patient performs a valsalva maneuver b. perform compression sonography over the suspicious area c. scan the patient in both inspiration and expiration d. rescan the patient following ingestion of a fatty meal e. scan the patient in a trendelenburg position
b. perform compression sonography over the suspicious area
Which of the following GI regions is composed of 5 individual wall layers? a. esophagus b. stomach c. duodenum d. cecum e. rectum
b. stomach
Which portion of the GI tract is most likely to demonstrate rugae? a. esophagus b. stomach c. duodenum d. transverse colon e. sigmoid colon
b. stomach
You suspect gut wall thickening in an elderly patient with abdominal pain and diarrhea. What is the normal average thickness of the gut wall? a. 1-2 mm b. 1-2 cm c. 3-5 mm d. 3-5 cm e. 6-7 mm
c. 3-5 mm
The diameter of the normal adult appendix should not exceed: a. 2 mm b. 4 mm c. 6 mm d. 8 mm e. 10 mm
c. 6 mm
You have been asked to perform graded compression sonography of the appendix in a young patient with questionable acute appendicitis. Which of the following describes the technique you will employ? a. quick, short compressions are performed in the right lower quadrant to assess pain and size of the appendix b. quickly push the probe as far into the abdomen and hold long enough to image the appendix and surrounding tissue c. apply gradual and uniform pressure with the probe over the area of interest d. push slowly and uniformly with the hand just superior to the probe and push the tissue into the field of view e. any of the above maneuvers can be used
c. apply gradual and uniform pressure with the probe over the area of interest
The most common location of the vermiform appendix is in the area of the: a. jejunum b. descending colon c. cecum d. sigmoid colon
c. cecum
Clinical findings of acute appendicitis include all of the following except: a. leukocytosis b. RLQ pain c. constipation d. rebound tenderness
c. constipation
Crohn disease most commonly occurs in which of the following regions? a. duodenum b. jejunum c. ileum d. cecum e. sigmoid
c. ileum
Red currant jelly stools are associated with what abnormality? a. diverticulosis b. appendicitis c. intussusception d. pyloric stenosis
c. intussusception
The duodenum protects the small intestines form chyme by secreting: a. bile b. pepsin c. mucus d. sodium bicarbonate e. cholecystokinin
c. mucus
You have performed a study to rule out appendicitis in a young female with RLQ pain. No evidence of appendicitis was detected. What should you do? a. nothing, the study is complete b. suggest the patient have a barium edema c. search for other causes of RLQ pain d. have the patient return in 24-48 hours for a repeat study if symptoms have not subsided e. b and d
c. search for other causes of RLQ pain
Which portion of the large intestines demonstrates the narrowest lumen? a. cecum b. ileum c. sigmoid d. ascending e. descending
c. sigmoid
The majority of food absorption occurs in which portion of the GI tract? a. stomach b. cecum c. small intestines d. ascending colon e. esophagus
c. small intestines
Pediatric patients could suffer from bowel obstructions that are caused by a buildup of ingested hair. The mass associated with this type of obstruction is termed a: a. phytobezoar b. lactobezoar c. trichobezoar d. permabezoar
c. trichobezoar
To be considered within normal limits, the length of the pyloric canal should not exceed: a. 10 mm b. 12 mm c. 15 mm d. 18 mm e. 21 mm
d. 18 mm
Traditionally, treatment for intussusception is by means of: a. surgery b. external manipulation c. compression sonography d. contrast enema
d. contrast enema
Gastritis is most likely described in sonographic terms as a(n): a. intraluminal target lesion b. absence of rugae in the stomach walls c. fluid-filled mass in the left upper quadrant d. diffuse thickening of the gastric walls e. poorly defined hypoechoic gastric mass
d. diffuse thickening of the gastric walls
All of the following are common clinical findings in infants that present with pyloric stenosis except: a. weight loss b. dehydration c. olive sign d. first-born female
d. first-born female
The sonographic finding of fluid-filled, distended loops of bowel is consistent with: a. meckel diverticulum b. diverticulitis c. gastroesophageal reflux disease d. intestinal obstruction
d. intestinal obstruction
Other abnormalities that can present much like pyloric stenosis include all of the following except: a. midgut malrotation b. pylorospasm c. gastroesophageal reflux disease d. intussusception
d. intussusception
Prolapse of one section of bowel into the lumen of another bowel segment describes which of the following conditions? a. ileus b. Crohn disease c. diverticulitis d. intussuscpetion e. Meckel diverticulum
d. intussuscpetion
The walls of the jejunum and ileum demonstrate small folds termed the: a. WES sign b. olive sign c. target sign d. keyboard sign e. doughnut sign
d. keyboard sign
What GI abnormality is sonographically diagnosed as an abnormal relationship between the superior mesenteric artery and superior mesenteric vein? a. pyloric stenosis b. intussuspection c. crohn disease d. midgut malrotation
d. midgut malrotation
Which of the following enzymes is produced by the stomach? a. gastrin b. lipase c. secretin d. pepsin e. amylase
d. pepsin
Forward movement of intestinal contents caused by rhythmic contractions of the intestines is termed: a. rugae b. pylrospasm c. cramping d. peristalsis e. haustral contractions
d. peristalsis
Functions of the GI tract include all of the following except: a. digest food b. secrete mucus into the intestines c. secrete digestive enzymes d. release glycogen as glucose e. absorb and break down food
d. release glycogen as glucose
Which of the following is considered a function of the duodenum? a. secrete pepsin b. produce lipase c. secrete hydrochloric acid d. secrete large quantities of mucous e. produce vitamin K and B complex
d. secrete large quantities of mucous
You are imaging the gut with a high-resolution transducer. How many layers do you except to see in a good imaging of the gut? a. 1 b. 2 c. 3 d. 4 e. 5
e. 5
You are imaging a patient with abdominal pain and detect multiple dilated fluid-filled loops of bowel. This is suspicious for which of the following? a. obstruction b. ileus c. lymphoma d. appendicitis e. a and b
e. a and b
You have detected an exophytic mass attached to the gut and suspect malignancy. You should tailor your exam to specifically evaluate what related pathology? a. regional lymph node enlargement b. liver metastasis c. pancreatic adenocarcinoma d. pancreatitis e. a and b only
e. a and b only
Which of the following best describes an abnormal sonographic appearance of the gut? a. target b. asymmetric target c. pseudokidney d. a and b only e. all of the above
e. all of the above
Which of the following is a classic sonographic feature of Crohn's disease? a. gut wall thickening b. strictures c. creeping fat d. increased vascularity e. all of the above
e. all of the above
You are imaging the abdomen in a patient with abdominal pain and weight loss. You detect an area that is suspicious for mass, but are considering the possibility that that mass is a normal loop of bowel. What should you do? a. have the patient return for a comparison study b. image the area for a short duration to see if peristalisis occurs c. scan the patient in a different position d. evaluate the area with color Doppler e. all of the maneuvers should be attempted if diagnostic confidence is not attained
e. all of the maneuvers should be attempted if diagnostic confidence is not attained
An elderly patient presents with a history of rectal bleeding and a change in normal bowel patterns. An irregular complex mass is identified in the rectum on an endorectal sonogram. On the basis of this history, the finding on the sonogram is most suspicious for: a. polyp b. fecalith c. diverticulum d. hemorrhoid e. carcinoma
e. carcinoma
Distention of the small bowel with fluid or air is associated with all of the following conditions except: a. peritonitis b. neoplasm c. renal colic d. acute pancreatitis e. gastroparesis
e. gastroparesis
Male infants have a predisposing factor for developing which of the following gastrointestinal conditions? a. ileus b. gastritis c. intussusception d. Meckel diverticulum e. hypertrophied pyloric stenosis
e. hypertrophied pyloric stenosis
The ileum is a section of the GI tract extending from the: a. duodenum to the cecum b. jejunum to the appendix c. duodenum to the appendix d. cecum to the ascending colon e. jejunum to the ileocecal junction
e. jejunum to the ileocecal junction
A patient has been referred for ultrasound evaluation to rule out acute appendicitis. What laboratory values are pathognomonic for acute appendicitis? a. leukocytosis b. increased AFP c. increased alkaline phosphatase d. increased serum bilirubin e. there are no pathognomonic lab values for acute appendicitis
e. there are no pathognomonic lab values for acute appendicitis
