Quiz: Gall bladder

Which of the following statements regarding gallstones aretrue?

A A- Biliary pain is typically refers to the epigastrium, left shoulder and the back. B B- The risk of having acute cholecystitis in a person with asymptomatic gallstones is 10 per cent/year. C C- Courvoisier's law is usually associated with gallstones. D D- Murphy's sign suggests the presence of acute inflammation.

An 88-year-old man with a history of end-stage renal failure, severe coronary artery disease, and brain metastases from lung cancer presents with acute cholecystitis. His family wants "everything done. The best management option in this patient would be

A A- Tube cholecystostomy B B- Open cholecystectomy C C- Laparoscopic cholecystectomy D D- Intravenous antibiotics followed by elective cholecystectomy

Which of the following is not a complication of gall stones?

A A- Gallbladder carcinoma B B- Intestinal obstruction C C- Ascending cholangiohepatitis. D D- Hepatocellular carcinoma

Which of the following is true about postcholecystectomy syndrome:

A a- Postoperative stricture is the most common cause of the syndrome B b- Dyskinesia may be the cause C c- ERCP is the investigation of choice D d- All of the above

The preferred treatment for carcinoma of the gallbladder is:

A a- Radical resection that includes gallbladder in continuity with the right hepatic lobe and regional lymph node dissection. B b- Radiation therapy. C c- Chemotherapy. D d- Palliative treatment

Which of the following lesions are believed to be associated with the development of carcinoma of the gallbladder?

A a- Cholecystoenteric fistula. B b- A calcified gallbladder. C c- Adenoma of the gallbladder. D d- All of the above.

Saint's triad includes all the following except:

A a- Achaiasia B b- Hiatus hernia C c- Chronic calcular cholecystitis D d- Diverticular disease of the colon

As regards treatment of acute cholecystitis all correct except:

A a- Cholecystectomy is the best treatment in early cases B b- Morphine is given to decrease pain of anxiety of patient C c- Modified Fowler's position is preferred D d- Failure of conservative treatment indicates cholecystostomy

T-tube should be removed:

A a- Once cholangiography is done to avoid fibrosis B b- After 4 days of operation if there is no missed stone C c- After at least 1 0 days of operation whatever the result of cholangiography D d- None of the above

Which of the following statements about cholangitis is incorrect:

A A. Charcot's triad is always present. B B. Associated biliary tract disease is always present. C C. Chills and fever are due to the presence of bacteria in the bile duct system. D D. The most common cause of cholangitis is choledocholithiasis.

Which statement about acute non calcular cholecystitis is correct?

A A. The disease is often accompanied by or associated with other conditions. B B. The diagnosis is often difficult. C C. The mortality rate is higher than that for acute calCUlOUS cholecystitis. D D. All of the above

As regards empyema of gall bladder all are correct except:

A a- Is a complication of gall stones B b- Leads to gall bladder mass C c- Is an indication for cholecystectomy D d- Should be treated by cholecystostomy

Characters of pain in acute cholangitis are the following except:

A a- Starts as colicky pain B b- Becomes dull aching with time C c- Throbbing pain means empyema formation D d- Referred to groin and inner side of thigh

Gas in the biliary system on a plain X-ray is diagnostic of

A a-Choledochoduodenal fistula B b-Intestinal obstruction C c- Emphysematous Cholecystitis D d-A and C

Which of the following statement(s) about gallstone ileus is/are not true?

A a- The condition is seen most frequently in women older than 70. B b- Concomitant with the bowel obstruction, air is seen in the biliary tree. C c- The usual fistula underlying the problem is between the gallbladder and the ileum. D d- When possible, relief of small bowel obstruction should be accompanied by definitive repair of the fistula since there is a significant incidence of recurrence if the fistula is left in place.

The best treatment of asymptomatic gall stone in diabetics is

A a- Prophylactic cholecystectomy B b- ESWL C c- Follow up D d- None of the above

The commonest presentation of gall stones is:

A a- Asymptomatic B b- Biliary colic C c- Charcot's triad D d- Jaundice

Which percentage of gall stones is radio-opaque:

A A. 10% B B. b- 40% C C. c- 70% D D. 90%

Without intraoperative T-tube cholangiography incidence of missed stone is:

A a. 10-20% B b. b- 40-50% C c. c- 70% D d. 80%

With intraoperative T-tube cholangiography incidence of missed stones is:

A a 0 % B b 5% C c 20% D d 30%

The best of the following investigations of gall stones is :

A a- Oral cholangiography B b- US C c- Plain X-ray D d- ERCP

The most accurate investigation to diagnose cholecystitis is:

A a- CT scan B b- IV cholangiography C c- HIDA scan D d- US

Kasai operation is for treatment of:

A a- Intrahepatic biliary atresia B b- Extrahepatic biliary atresia C c- Caroli's disease D d- Choledochai cyst

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