MCQ – ANSWERS: INTESTINAL OBSTRUCTION

Clinical
Small Gut
1- What are the cardinal signs of obstruction syndrome?
A. Abdominal pain and cramping
B. Nausea, vomiting
C. Unable to pass stool or gas
D. Abdominal guarding.
E. Abdominal fullness, gaseous, distention

2. History and physical examination permit the diagnosis of intestinal obstruction in most cases. Which of the following are important for the clinical diagnosis of small bowel obstruction?
A. Crampy abdominal pain.
B. Fever.
C. Vomiting.
D. Abdominal distention.
E. Leukocyte count above 12,000.
F. Abdominal tenderness.

3. Which of the following statement(s) is/are true concerning the pathophysiology of small bowel obstruction?
A. Most of gas seen on plane abdominal radiographs is produced by gas forming microorganisms.
B. Elevation of luminal pressure contributes to fluid accumulation in the small bowel in closed loop but not open loop small bowel obstructions.
C. Intestinal blood flow initially increases to the bowel wall in early bowel obstruction.
D. In the face of obstruction, myoelectrical activity of the bowel is consistently increased.

4. The lamina propria between the intestinal epithelium and the muscularis mucosae contains:
A. Blood and lymph vessels.
B. Undifferentiated epithelial cells.
C. Nerve fibers.
D. Enterochromaffin cells.
E. Macrophages.
F. Connective tissue.

5. Regarding small bowel obstruction
A. In the United Kingdom is most often due to an obstructed hernia.
B. Causes colicky abdominal pain and vomiting.
C. Abdominal distension is seen in all patients.
D. All cases can be managed conservatively for the first 24 hours.
E. Rarely requires aggressive fluid resuscitation.

6. Regarding strangulated small intestine obstruction:
A. Pain syndrome occurs brutally.
B. Abdominal meteorism is central.
C. Vomiting are early and abundants.
D. Infectious syndrome is right away important
E. Douglass pouch is pain on rectal palpation.

7. A mechanism of strangulation in acute bowel obstruction is suspected when:
A. Continuous pain.
B. Sign Von Wahl.
C. Air-fluid noises.
D. Hiccups.

8. Occlusion in strangulation of the small intestine:
1: The pain syndrome begins abruptly.
2: The central abdominal bloating.
3: Vomiting is early and abundant.
4: The infectious syndrome is important from the outset.
5: The cul de sac (uterorectal or vesicorectal pouch) is painful at rectal examination.
A: 1-5-4 B:1-4-3 C: 1-2-3 D: 2-3-5 E :1-2-5

9. During the paralytic ileus, all signs those are common except one, which one?
A. Abdominal distension,
B. Iincreased-fluid noises on auscultation,
C. Abdominal pain discrete
D. Radiological small bowel distention and colon
E. Low fluid levels .

10. Extracellular dehydration:
A. Can be installed as a result of vomiting or biliary fistula.
B. Accompanied by dryness of mucous.
C. Its treatment involves the administration of saline.
D. Biologically accompanied the increase in the Ht and the rate of protein.
E. Accompanied by the skin pinch.

11. In acute intestinal obstruction by strangulation of the small intestine recent physical examination can establish that:
A - A central bloating.
B - Peristaltic waves.
C - An abdominal scar.
D - A contracture periumbilical.
E - Air-fluid noises on auscultation.

12. Before a bowel obstruction which (s) is (are) on (the) item (s) for a small bowel obstruction due to strangulation?
A - The gradual onset of pain.
B - The existence of an abdominal scar.
C - No matter the digital rectal examination.
D - The permanent nature of the pain.
E - The absence of fluid levels on radiographs of the abdomen without preparation.

13. For a mechanism of strangulation during acute intestinal obstruction is retained:
A - Existence of peristaltic waves.
B - Silence abdominal auscultation.
C - Early progressive.
D - Presence of an abdominal scar.
E – Pain with DRE.

14. Obstruction due to strangulation of small bowel clamp (frange, adhesion) is characterized by:
A - A sudden onset.
B - Severe pain.
C - Vomiting late.
D - Images with air-fluid folds haustraux on radiographs of the abdomen without preparation.
E - Images air-fluid level which shows the folding of the small intestine.

15. A mechanism of obstruction in acute bowel obstruction is suggested by:
A - Curl peristaltic.
B - Silence has abdominal auscultation.
C - Asymmetry of bloating.
D - Emptiness of the rectum to the touch.
E - Conservation of the general condition.

16. The small bowel obstruction by strangulation is characterized by:
A - Start brutal.
B - Important abdominal distension.
C - Strong intensity of abdominal colic.
D - Earliness vomiting.
E - Air-fluid level higher than wide.

17. A mechanism of strangulation in acute bowel obstruction is suggested by:
A - Constant pain.
B - Sign of Von Wahl.
C - Air-fluid sounds on auscultation.
D - Abdominal contracture.
E - Hiccups.

18. The location in the small intestine to acute intestinal obstruction by strangulation is suspected in:
A - Central bloat peri-umbilical.
B - Presence of peristaltic waves.
C - Asymmetrical arrangement of bloat.
D - Precocity and abundance vomiting.
E - Abdominal contracture.

19. In paralytic ileus, all the signs that are common but one. Which one?
A - Abdominal distension.
B - Increase in noise-fluid for the inspection.
C - Abdominal pain discreet.
D - Radiological small bowel distention and bowel.
E - Low fluid levels.

20. In the presence of an acute intestinal obstruction syndrome, all signs may be observed during a paralytic occlusion with the exception of one. Indicate which:
A - Important abdominal bloating.
B - No fever.
C - Retention of urine reflex.
D - Curl peristaltic. (Ondulations peristaltic).
E - Hiccups.

21. One definition is the following gallstone ileus. Which one?
A - A choledochal gravel gallstones. (empierrement)
B - A peritonitis by gallbladder perforation.
C - Inflammatory bowel obstruction in contact with acute cholecystitis.
D - A small bowel obstruction by migration of gallstones.
E - None of the above is correct.
Answer: D

22. For a mechanism of strangulation during an acute intestinal obstruction is retained:
A - Existence of peristaltic waves.
B - Silence abdominal auscultation.
C - Early progressive.
D - Presence of an abdominal scar.
E - Pain with digital rectal examination.

23. Concerning the adhesion volvulus of the small intestine:
A - The flange (s) may take (s) be congenital.
B - In case of single flange, it sits constantly at the foot of the vuvolus loop.
C - The direction of twist of the handle is either clockwise or counter-clockwise.
D - The expansion only affects intestinal bowel volvulus upstream of and respects the vuvolus loop.
E - The maximum anatomical lesions seat at the foot of the vuvolus loop.

24. A mechanism of obstruction in acute bowel obstruction is suggested by:
A - Curl peristaltic.
B - Silence has abdominal auscultation.
C - Asymmetry of bloating.
D - Emptiness of the rectum to the touch.
E - Conservation of the condition.

25. The small bowel obstruction due to strangulation is characterized by:
A - Sudden onset.
B - Abdominal distension important.
C - High intensity colicky abdominal.
D - Precocity vomiting.
E - Air-fluid level higher than wide.

26. On the occasion of an acute intestinal obstruction which of the following proposals, the one you remember?
A - Pneumoperitoneum.
B - Air-fluid level higher than wide.
C - Bulky abdominal distension.
D - Abdominal contracture.
E - None of these.

27. What are the signs accompanying occlusion by volvulus of the small intestine?
A - Sudden onset.
B – Bloat immobile.
C - Minor abdominal pain.
D - Auscultation Abdominal silent.
E - Early vomiting.

28. In acute intestinal obstruction due to strangulation of the small intestine recent physical exam may find:
A - A central bloating.
B - Peristaltic waves.
C - An abdominal scar.
D - A periumbilical contracture.
E - Air-fluid noises on auscultation.

29. In strangulation obstruction of the small intestine, bloating is:
A. Sudden onset.
B. Central.
C. Noise with air-fluid on auscultation.
D. Animated peristaltic waves.
E. Sound on percussion.

30. A bloat of obstruction in acute bowel obstruction is suspected when:
A. Peristaltic undulations.
B. Abdominal silence.
C. Asymmetry of bloat.
D. Conservation condition.

Large Gut

1. One of the following sign is characteristic of an occlusion of the sigmoid volvulus. Which?
A - Fever Early.
B - Bloat oblique.
C - Blood on rectal examination.
D - All of distension of the colon in the abdomen with preparation.
E - Liquid Levels colic. Colonic fluid level

2. Occlusion of the sigmoid colon cancer is characterized by:
A. Gradual onset.
B. Significant (important) abdominal bloating.
C. Intensive abdominal colic.
D. A large number of air fluid levels.
E. Air fluid levels higher than wide.

3. Bloat of the pelvic colon volvulus:
1. Has an asymmetrical layout.
2. Was tympanic to percussion.
3. Accompanied by peristaltic waves.
4. Accompanied by abdominal contraction.
5. Accompanied by removal of abdominal skin reflexes
A: 1-4 B: 2-3 C: 1-2 D: 3-5 E: 1-5

4. One of the following is characteristic of a sigmoid volvulus:
A. Fever early.
B. Bloat oblique.
C. Distension of the colon together with the ASP.
D. Colonic fluid level.

5. Occlusion of the sigmoid colon cancer is characterized by:
A- Beginning progressive.
B- Abdominal distension important.
C- Strong intensity of abdominal colic.
D- A large number of air-fluid level.
E- Air-fluid levels higher than wide.

6. The distension of the pelvic colon volvulus:
A - A an asymmetrical arrangement.
B - Is tympanic to percussion.
C - Comes with peristaltic waves.
D - Accompanied by abdominal contraction.
E - Comes with removal of abdominal cutaneous reflexes.

7. Among the various claims about the cecal volvulus include one (s) is (are) true (s):
A - There may be secondary to an absence of apposition of the cecum.
B - He was a frequent early clinical brutal.
C - Vomiting is often hemorrhagic.
D - The cessation of materials and gas net.
E - The pain is often intense.

8. The occlusion of the sigmoid colon cancer is characterized by:
A - Early progressive.
B - Abdominal distension important.
C - High intensity of abdominal colic.
D - A large number of air-fluid level.
E - The air-fluid level higher than wide.

9. The bloating of pelvic colon volvulus:
A - In an asymmetrical arrangement.
B - Is tympanic to percussion.
C - Comes with peristaltic waves.
D - is accompanied by abdominal contraction.
E - Comes with removal of abdominal cutaneous reflexes.

10. Among the various claims about the cecal volvulus include one (s) is (are) true (s):
A - It may be secondary to a lack of apposition of the cecum.
B - He was frequently a brutal early clinical.
C - Vomiting is often hemorrhagic.
D - The cessation of material and gas net.
E - The pain is often intense.

11. Koenig's syndrome is characterized:
A - Abundant steatorrhea.
B - In crises subocclusives resolve spontaneously.
C - A flush.
D - By recurrent gastrointestinal bleeding.
E - By fever joint pain with chronic diarrhea.

12. Indicate from the following, the (s) character (s) taken by the abdominal distension in cases of bowel obstruction when he realizes a sign of von Wahl:
A - Arranged in the frame.
B - Tympany to percussion.
C - Consistency elastic to the touch.
D - Presence of peristaltic waves.
E - Abdominal contracture.

13. Occlusion by neoplastic stenosis of the hinge rectosigmoid:
A. a mode is usually faster.
B. accompanied by vomiting early.
C. has a total silence on auscultation abdominal.
D. causes bloating in part (part in a flatulence).
E. may be preceded by rectal hemorrhage.

14. Of the following characters, which ones can not (usually) apply to the sigmoid volvulus?
A. Sudden onset.
B. Early vomiting.
C. Central bloat.
D. Many fluid levels.
E. Endoscopic treatment.

15. Indicate from the following, the (s) character (s) taken by the abdominal distension in cases of bowel obstruction when he realizes a sign of von Wahl:
A. Available in part.
B. Tympany to percussion.
C. Elastic consistency on palpation.
D. Presence of peristaltic waves.
E. Abdominal contraction.

16. In an occlusion of the left colon obstruction:
A. vomiting are early and abundant.
B. bloat is peripheric.
C. the peristaltic waves are numerous.
D. air-fluid sounds on auscultation are evident.
E. images radiological air-fluid are higher than wide.

Causes

1- Quote the 2 causes of obstruction small intestine by obstruction of the bowels:
A. Volvulus
B. Bilary ileus
C. Tumors blocking the intestines
D. Electrolyte imbalances.

2- Quote the 3 causes of intestinal obstruction by strangulation of the bowels:
A. Postoperative adhesions.
B. Obstruction intestine by mesenteric tumor.
C. Volvulus (twisted intestine).
D. Foreign bodies (ingested materials that obstruct the intestines).
E. Hernias (strangulated hernia).

3. Complete mechanical small bowel obstruction can cause dehydration by:
A. Interfering with oral intake of water.
B. Inducing vomiting.
C. Decreasing intestinal absorption of water.
D. Causing secretion of water into the intestinal lumen.
E. Causing edema of the intestinal wall.

4. A 45-year-old man with a history of previous right hemicolectomy for colon cancer presents with colicky abdominal pain which has become constant over the last few hours. He has marked abdominal distension and has had only minimal vomiting of a feculent material. His abdomen is diffusely tender. Abdominal x-ray shows multiple air fluid levels with dilatation of some loops to greater than 3 cm in diameter. The most likely diagnosis is:
A. Proximal small bowel obstruction.
B. Distal small bowel obstruction.
C. Acute appendicitis.
D. Closed-loop small bowel obstruction.

5. In the patient described above, the following statement(s) is/are true concerning the possible etiology of bowel obstruction.
A. Simple obstruction secondary to an adhesion is most likely to resolve nonoperatively.
B. It is most likely that the patient’s obstruction is secondary to recurrent malignancy.
C. A history of colon cancer makes carcinomatosis the most likely diagnosis.
D. Lower abdominal procedures are more likely to result in obstructive adhesions than are upper abdominal procedures.

6. Which of the following statement(s) is/are true concerning the etiology of intestinal obstruction?
A. In the United States, peritoneal adhesions account for over half of the cases of small bowel obstruction.
B. A leading cause of bowel obstruction is early postoperative adhesions.
C. Bowel obstruction cannot occur with a Richter’s hernia.
D. Ninety percent of adult cases of intussusception are associated with a pathologic process, most commonly a tumor.

7. Which of the following statement(s) is/are true concerning Intestinal Obstruction?
A. Any impairment, arrest, or reversal of the normal flow of intestinal contents toward the anus.
B. Intestinal obstruction is a blockage of your small intestine or colon that prevents food and fluid from passing through.
C. Interruption in the passage of intestinal contents.
D. Intestinal obstruction is a partial or complete blockage of the bowel that results in the failure of the intestinal contents to pass through.
E. Bowel obstruction (or intestinal obstruction) is a mechanical or functional obstruction of the intestines, preventing the normal transit of the products of digestion.

8. Most iron is stored in combination with?
A. Sulphate.
B. Ferritin.
C. Transferrin.
D. Ascorbic acid.

9. The following are true of colonic volvulus
A. Cecal volvulus is associated with malrotation.
B. Cecal volvulus is commonest in children.
C. In sigmoid volvulus the amount of torsion is most commonly 360 degrees.
D. In sigmoid volvulus the 'coffee-bean sign' is due to distinct midline crease corresponding to the mesenteric root in a distended loop.
E. Volvulus of the transverse colon accounts for about 10% of all colonic volvulus.

10. Among obstructions of newborn, one of the following aetiologies can complicate severe enterocolitis, indeed deadly necessary always emergency treatment what?
A. Hirschsprung’s disease.
B. Ileal atresia.
C. Meconial ileus.
D. Left little colon syndrome.

11. Certain intestinal obstructions can lead partial or complete ischemic necrosis of small gut, what?
A. Strangulated inguinal hernia.
B. Appendiceal peritonitis.
C. Intussusception.
D. Meconial ileus.
E. Duodenal atresia.
F. Hirschsprung’s disease.

12. Of the following characters, indicate that applying to gallstone ileus:
A - Is the result of the isolation of a calculation at the neck region cystic?
B - Its evolution is dominated by the risk of intrahepatic suppuration.
C - Is always associated with a vesicle large, tense, and palpable.
D - Is responsible for a small bowel obstruction.
E - The calculation is always pure, consisting of calcium bilirubinate.

13. Concerning volvulus flange of the small intestine (on adhesion)
A. The flange may be congenital.
B. In case of single flange, it sits constantly at the foot of the twist loop.
C. The meaning is twisting the handle is either clockwise or counterclockwise.
D. The expansion affects only the intestinal gut volvulus and upstream of the loop volvulus respects.
E. The maximum anatomical lesions seat at the foot of the twist loop.

14. Among the following which ones can be retained as a cause of intestinal obstruction by strangulation?
1. The occlusion of the sigmoid cancer.
2. The occlusion by volvulus flange.
3. The gallstone ileus.
4. The strangulated hernia.
5. The acute intussusception.
A: 1-4-5 B:1- 2-3 C: 1-2-4 D: 2-4-5 E :1-3-5

15. Hypokalemia:
A. Can cause paralytic ileus.
B. May cause muscle paralysis.
C. May cause cardiovascular events early on ECG.
D. Is often the result of renal and gastrointestinal losses?
E. Is never seen in drowning.

16 - Elements radiological evidence of organic obstruction stenosing cancer of the sigmoid:
A. Distension smooth, mainly gaseous bowel loops and colon
B. Images-fluid devices taller than wide
C. Large image hydroaeric of median lower abdominal
D. Thickening of the walls of small bowel with effacement of the valves connivent

17. A passenger presents severe abdominal pain by moving crisis amid ongoing pain, and vomiting with lost materials and gases. The review shows that you practice a distended abdomen without contracture. You think
A- Appendicitis.
B- Ruptured ectopic pregnancy.
C- Hepatic colic.
D- Intestinal obstruction.

18. Some intestinal obstructions are accompanied by a partial or total ischemic necrosis of the small intestine. Which?
A. Strangulated inguinal hernia.
B. Peritonitis.
C. Volvulus on common mesentery.
D. Intussusception.
E. Meconium ileus.
F. Hirschsprung's disease.
G. Duodenal atresia.
H. Occlusion flange.

19. A bite fever in intestinal obstruction can be indicative of the form:
A - Pelvic appendicitis.
B - Appendicitis mesoceliac.
C - Retro-caecal appendicitis.
D - The appendiceal abscess.
E – Appendicular peritonitis.

20. The gallstone ileus can be the result of fistula:
A - Cholecysto-colic.
B - Cholecysto-duodenal.
C - Cholecysto-choledochal.
D - choledocho-choledochal.
E - Hepatico gastric.

21. Among the conditions proposed as responsible for an inflammatory occlusion, the quote (s) is (are) true (s):
A - Gallstone ileus.
B - Renal colic.
C - Cholecystitis.
D - Sigmoiditis.
E - Peritonitis.

22. Among of the following causes of obstruction by strangulation proposed, what (s) is (are) one (s) is (are) true (s)?
A - Crohn's Disease.
B - Strangulated inguinal hernia.
C - Volvulus flange.
D – Biliary ileus.
E – Acute Intussusception.

23. A mechanism of obstruction in acute bowel obstruction is suggested by:
A - Curl peristaltic.
B - Silence has abdominal auscultation.
C - Asymmetry of bloating.
D - Emptiness of the rectum to the touch.
E - Conservation of the condition.

24. An occlusion febrile (bite fever) can be indicative of the form:
A - Pelvic appendicitis.
B - Meso-celiac appendicitis.
C - Retro-cecal appendicitis.
D - The appendiceal abscess.
E - The peritonitis.

25. The gallstone ileus may be due to a fistula:
A - Cholecysto-colic.
B - Cholecysto-duodenal.
C - Cholecysto-choledochal.
D - choledocho-choledochal.
E - Hepatico tube.

26. Among the conditions proposed as responsible for an inflammatory occlusion, the quote (s) is (are) true (s):
A - Gallstone ileus.
B - Renal colic.
C - Cholecystitis.
D - Sigmoiditis.
E - Peritonitis.

27. For the organic character of constipation, you hold:
A - Recent onset in a patient over 40 years.
B - General condition preserved.
C - Anemia associated.
D - Rectal bleeding.
E - Old and stable symptoms.

28. Among of the following causes of occlusion proposed by strangulation, what (s) is (are) one (s) is (are) true (s)?
A - Strangulated hernia.
B - Cancer of the colon.
C - Intestinal volvulus.
D - Intestinal infarction.
E - Bride scar.

29. Which of the following, the two most common causes of colonic obstruction organic outside the sigmoid cancer in an adult?
A - The sigmoid volvulus.
B - Ischemic colitis.
C - Ulcerative colitis.
D - The sigmoid diverticular.
E - The colo-colonic intussusception.

30. Hirschsprung's disease:
A. is a particular form of colon volvulus.
B. is an occlusion by stenosis of the small intestine.
C. is an occlusion by atresia in the colon.
D. is an occlusion by abnormal nerve plexus intraparietal.
E. is an occlusion by functional enzyme disorder.

31. Among of the following causes of occlusion proposed by strangulation, what (s) is (are) one (s) is (are) true (s)?
A. Crohn's disease.
B. Inguinal hernia.
C. Volvulus flange.
D. umbilical hernia.
E. Stenosis of the sigmoid colon cancer.

32. Among the neonatal low occlusions, one of the following causes may be complicated by enterocolitis extremely serious, even fatal, always requiring emergency treatment. Which?
A. Hirschsprung disease.
B. Ileal atresia.
C. Meconium ileus (cystic fibrosis).
D. Small left colon syndrome.

Investigations

1- The most helpful diagnostic radiographic procedure in small bowel obstruction is:
A. CT of the abdomen.
B. Contrast study of the intestine.
C. Supine and erect x-rays of the abdomen.
D. Ultrasonography of the abdomen.

2. Patients with established, complete, simple, distal small bowel obstruction usually have the following findings on plain and upright abdominal radiographs:
A. Distended small bowel identifiable by the valvulae connivances.
B. Multiple air-fluid levels.
C. Modest amount of gas in the pelvis.
D. Peripheral, rather than central, distribution of gas.
E. Prominent haustral markings.
F. Free air.

3. Which of the following statement(s) is/are true concerning laboratory tests which might be obtained in the patient discussed above?
A. The presence of a white blood cell count > 15,000 would be highly suggestive of a closed-loop obstruction.
B. Metabolic acidosis mandates emergency exploration.
C. An elevation of BUN would suggest underlying renal dysfunction.
D. There is no rapidly available test to distinguish tissue necrosis from simple bowel obstruction.

4. The patient discussed above was admitted to the hospital and after 24 hours remained distended with no evidence of resolution. Which of the following radiographic studies would be considered appropriate at this time?
A. Contrast enema.
B. Enteroclysis study with dilute barium.
C. CT scan with dilute barium oral contrast.
D. None of the above.

5. The most helpful diagnostic radiographic procedure in small bowel obstruction is:
A. CT of the abdomen.
B. Contrast study of the intestine.
C. Supine and erect x-rays of the abdomen.
D. Ultrasonography of the abdomen.

6. What is/are among the following radiological elements which reveal a biliary ileus?
A. Air under diaphragmatic.
B. Air-fluid level of small gut.
C. Aerobilia.
D. Enlargement parieto-colic groove.

7. What is/are among the following radiological elements which permit to diagnose a small gut obstruction on erect film (APF)?
A. Central air-fluid level.
B. Air-fluid level higher than larger.
C. Aerobilia.
D. Air under diaphragmatic.

8. On erect film in intestinal subobstruction patient reveals an isolated loop dilated with air-fluid level. What diagnosis can be evoked?
A. Colon volvulus.
B. Peritonitis.
C. Deep abscess.
D. Pancreatitis.
E. Cholecystitis.

9. Which is, among the following radiological features that allow you to diagnose small bowel obstruction on plain films of abdomen without preparation?
A. Image central air-fluid level.
B. Image air-fluid level wider than tall. (than higher)
C. Presence of dents and haustra thickened the walls of the distended loops.
D. Aerobilia.
E. Increasing clear subdiaphragmatic gas.

10. What is the review for asserting Hirschsprung's disease?
A. The barium enema.
B. Anorectal manometry.
C. Rectal biopsy.
D. The rise of a rectal probe.

11. What (s) is (are) among the following radiological signs, that (those) which translate (are) a gallstone ileus:
A - Crescent clear subdiaphragmatic gas.
B – Images fluid level of the small intestine.
C - Pneumobilie (pneumobilia).
D - Enlargement of the paracolic gutters.
E - Image parietography gaseous intestinal loops.

12. What (s) is (are) among the following radiological elements that (those) that will allow (s) to diagnose small bowel obstruction on plain films of abdomen without preparation?
A – Images central fluid level.
B - Images fluid level higher than wide.
C - Presence of dents and Haustrate thickened the walls of the distended loops.
D - Pneumobilia.
E - Crescent clear subdiaphragmatic gas.

13. What (s) is (are) among the following radiological elements that (those) which demonstrates occlusion of organic stenosis of the sigmoid colon cancer?
A - Abdomen smooth, mostly pop, small bowel and colon.
B - Images-fluid devices taller than wide.
C - Air in the rectum.
D - Thickening of the walls of small bowel loops with "erasing valves connivent".
E - Bulky image hydroaeric arched pelvic lower abdominal median.

14. What (s) is (are) among the following radiological elements that (those) that will allow to diagnose obstruction of the small intestine on image of abdomen urgent?
A – Central image fluid level.
B - Opacities gutters laterobladder "in ear dog".
C - Presence of dents and Haustrate thickened the walls of the distended loops.
D - Pneumobilia.
E - Crescent clear subdiaphragmatic gas.

15. A malignant tumor of the colon can give an obstruction:
A. By strangulation.
B. With early cessation of materials and gases.
C. Pictures with air-fluid devices.
D. Air-fluid with images wider than high.
E. Can provide a framework in bloating.

16. Regarding an occlusive syndrome, it is advisable to:
A. Do a rectal examination.
B. Feel the hernial orifices.
C. To perform an abdominal preparation.
D. To perform an enema with water-soluble.
E. Feed the patient.

17. An occlusion of the left colon obstruction:
A. Vomiting are early and abundant.
B. Bloat is peripheric.
C. The peristaltic waves are numerous.
D. Air-fluid sounds on auscultation are evident.
E. Image radiological air-fluid is higher than wide.

18. Obstruction by obstruction of the small intestine leads to:
A. A median abdominal distension.
B. Meteorism a lively peristaltic movement.
C. Stopping materials and gas early.
D. Many images air-fluid.
E. Air-fluid images taller than wide.


Complications

19. Which of the following statement (s) is/are true concerning postoperative ileus?
A. The use of intravenous patient-controlled analgesia has no effect on return of small bowel motor activity.
B. The presence of peritonitis at the time of the original operation delays the return of normal bowel function.
C. The routine use of metoclopramide will hasten the return of small intestinal motor activity.
D. Contrast radiographic studies have no role in distinguishing early postoperative bowel obstruction from normal ileus.

Treatment

1. A 75-year-old woman is hospitalized after a fall in which she has experienced a hip fracture. Several days after her surgical procedure, progressive painless abdominal distension is noted. Which of the following statement(s) is/are true concerning her diagnosis and management?
A. Colon distension with a cecal diameter in excess of 12 cm should indicate the need for urgent operation.
B. Endoscopic decompression may be attempted but seldom is successful.
C. After successful colonoscopic decompression, recurrence is unlikely.
D. A rectal tube as the primary treatment is generally not successful.

2. The initial management of this patient should consist of:
A. Fluid resuscitation with D5 half normal saline with 40 mEq of potassium chloride/liter
B. Placement of an indwelling urinary catheter.
C. Nasogastric decompression with a nasogastric tube.
D. Immediate surgery
E. The patient should be begun on broad spectrum antibiotics at the time of admission

3. An 82-year-old female nursing home resident is admitted with massive abdominal distension and constant abdominal pain with diffuse tenderness. Abdominal x-ray shows a massively distended loop of colon with a characteristic “bent inner tube” appearance. The management of this patient should include:
A. Urgent laparotomy because of the massive colon distension.
B. An attempt at endoscopic decompression with a flexible sigmoidoscope.
C. Elective laparotomy and sigmoid resection should follow if endoscopic decompression is successful.
D. If at urgent laparotomy resected bowel is present, colon resection with primary anastomosis is in order.


Intussusception

Clinical

1. Intussusception
A. Is most common in children from 6 to 12 years.
B. Presents with colicky abdominal pain, rectal bleeding and an abdominal mass.
C. 10% present with diarrhoea and vomiting suggestive of gastroenteritis.
D. If no shock or peritonitis hydrostatic reduction can be attempted.
E. A Meckel's diverticulum can induce an intussusception.

2. Regarding acute intussusception (AI), one of the following statements is true:
A – A.I. is a condition seen mainly between two and six.
B - The absence of rectal eliminates the diagnosis of A.I.
C - Intussusception can descend into the left colon.
D - A barium enema removes a normal A.I.
E - The standard radiological reduction of A.I. is the visualization of the cecum.

3. In case of intussusception in infants, a sign is virtually pathognomonic. Which?
A- Rectal bleeding
B- Paroxysmal abdominal pain
C- Emptiness of the right iliac fossa
D- Palpation of an intussusception
E- association pain, rectal bleeding

4. Regarding trans-valvular ileo-ileocolic intussusception: what are the true statements?
A- It was born on the colon
B- It is usually idiopathic
C- It is often resistant to radiation treatment
D- Appendix is driven in trans-valve with the flange
E- It can be caused by a Mekel diverticulum

5. Which of the following statement(s) is/are true concerning Intussusception?
A. A form of intestinal obstruction caused by the prolapse of a part of the intestine into the adjoining intestinal lumen.
B. Intussusception involves a telescoping of one portion of the intestine into another, which results in decreased blood supply of the involved segment.
C. Intussusception is the sliding of one part of the intestine into another.
D. Intussusception is a term derived from the Latin intus (within) and suscipere (to receive). One segment of the bowel (intussusceptum) invaginates into another (intussuscipiens) just distal to it, leading to obstruction. The bowel may simply telescope on itself (non-pathological lead point), or some pathology may be the focus of the invagination (pathological lead point).
E. Intussusception is defined as the telescoping of one segment of bowel into the immediately distal segment of bowel.

6. Claw sign seen in?
A. Intusseption.
B. Volvulus.
C. Adhesion.
D. Impacted feces

7. The acute intussusception:
A. Is observed mainly between 2 and 6 years
B. The absence of rectal bleeding diagnosis eliminates
C. A barium enema diagnosis eliminates normal
D. The strand of intussusception can descend into the left colon

8. Constipation is a symptom
A. Which is defined by a dry weight of stools> 22% of the total weight of these
B. Which can be enhanced by ingestion of magnesium salts
C. Can be improved by the continued use of its 15g / d

9. Regarding acute intussusception (AI), one of the following statements is true:
A - AI is a condition seen mainly between two and six.
B - The absence of rectal eliminates the diagnosis of AI.
C - intussusception can descend into the left colon .
D - A barium enema removes a normal AI.
E - The standard radiological reduction of AI is the visualization of the cecum.

Cause

10. Of the following etiological hypotheses, what is the one we should not use it as a possible cause of intussusception secondary?
A - Meckel's diverticulum,
B - Common mesentery.
C - Intestinal duplication cyst.
D - Lymphosarcoma,
E - Rheumatoid purpura.

11. Acute abdominal pain in children can be caused by:
A - An ovarian cyst in the little girl,
B - Meckel's diverticulum,
C - Testicular torsion in boys,
D - Bladder retention,
E - Pneumonia.

12. Cases of intussusception:
A. Nasopharyngeal infection
B. Meckel diverticulum
C. Intestinal lymphoma
D. Thrombocytopenic purpura
E. HSP

Investigation
13. What (s) image (s) radiological (s) can we see the enema of an infant who has an intussusception?
A - A picture sleeve sigmoid (en virole)
B - A gap in the cecum, (lacune)
C - An image of the Rosette splenic flexure.
D - A lobster claw image of the transverse colon,
E - A stack of plates aspect of the transverse colon,

14. How (s) review (s) may be appealed to explore first-line acute abdominal pain in children?
A - Small bowel transit,
B - Chest x-ray,
C - CT abdominal
D - Abdominopelvic ultrasound,
E – GI Barium.

15. The criteria for reduction of intussusception in the time course of barium enema are:
A - Image cockade
B - Frank fill the last intestinal loops,
C - Post-traumatic stenosis,
D - Visibility of the cecum in place,
E - No filling of the last intestinal loops.

16. Complete Rx of intussception indicates?
A. Free passage of barium in the small intestine.
B. Passage of faceus and flatus along with barium.
C. Improvement of clinical condition.
D. Claw sign.

17. To affirm the complete reduction by enema of intussusception valvulo-colic (caeco-colic), you must require:
A - A complete opacification of the right colon.
B - A complete opacification of the cecum.
C - A clouding of the appendix.
D - A frank and massive opacification of small bowel loops past.
E - One aspect curved inward toward the midline of the cecum and right colon.

Complication
18. All following injury or illness may be complicated by intussusception, except one:
A - Nasopharyngeal infection.
B - Meckel's diverticulum.
C - Intestinal lymphoma.
D - Thrombocytopenic purpura.
E - Purpura arthritis.


Biliary Ileus
1. What (s) is (are) among the following radiological signs, that (those) which reflect a gallstone ileus:
A - Ascending clear subdiaphragmatic gas.
B - Images-fluid of the small intestine.
C - Pneumobilie (pneumobilia).
D - Enlargement of the paracolic gutters.
E - Image parietography gaseous small bowel loops.

2. One definition is the following gallstone ileus. Which one?
A - A choledochal gravel gallstones. (empierrement)
B - A gallbladder perforation peritonitis.
C - Inflammatory bowel obstruction in contact with acute cholecystitis.
D - A small bowel obstruction by migration of gallstones.
E - None of the above is correct.

3. The gallstone ileus may be due to a fistula:
A - Cholecysto-colic.
B - Cholecysto-duodenal.
C - Choleysto-choledochal.
D - choledocho-choledochal.
E - Hepatico tube.

4. Indicate the exact proposal regarding gallstone ileus:
A. It comes with a pneumoperitoneum.
B. it is accompanied by a pneumobilia.
C. It produced an array of small bowel obstruction due to strangulation.
D. it is accompanied by jaundice.
E. it complicates an microlithiasis.

5. Indicate the exact proposal regarding gallstone ileus:
A. It comes with a pneumoperitoneum.
B. it is accompanied by a pneumobilia.
C. he produced a table of small bowel obstruction due to strangulation.
D. it is accompanied by jaundice.
E. it complicates an microlithiasis.


Clinical case

Clinical case A
A man aged 80 was hospitalized because of abdominal pain by moving crises, accompanied by a cessation of materials and gas and a feeling of nausea. In this patient, chronic constipation, trouble began two to three days before. Several similar attacks identified in the background had given spontaneously or after an enema. A review is an important abdominal distension, oblique and asymmetric. The patient is afebrile, the general condition is poor. The diagnosis of intestinal obstruction is discussed.

A1. The head of the colonic obstruction is suggested by:
A - Early to stop gas.
B - Bloating oblique and asymmetrical.
C - abdominal contracture.
D - Emptiness of the rectum to the touch.
E - Impairment of condition. (General state)

A2. You have made an x-ray of abdomen without preparation that confirms your clinical impression of pelvic colon volvulus. Indicate from the following (s) sign (s) radiological (s) compatible (s) with this diagnosis:
A - Anse dilated sole occupant most of the abdomen.
B - on multiple levels liquids hail.
C - Presence of a peritoneal effusion reaction.
D - Grand liquid level at the dilated loop.
E - Discharge of the liver shadow.


A3. The occurrence of pelvic colon volvulus is enhanced by:
A - Existence of dolichocôlon.
B - Presence of diverticula.
C - History of previous attacks of diverticulitis.
D - Existence of fibrous bands of the mesocolon.
E - Association of a tumor of the hinge rectosigmoid.

A4. In this patient, which of the following therapeutic measures do you recommend in an emergency?
A - Cleansing enema.
B - Untwisting by external manipulation.
C - Colonoscopy.
D - Sigmoid colostomy.
E - Sigmoid colectomy in an emergency.


Clinical case B
One patient of 78 years was hospitalized for intestinal obstruction. It has since morning arrest of materials and gas net and absolute, a meteorism important. There is a history of bowel dysfunction. The beginning, there are 3 or 4 days, was marked by vague abdominal pain colicky, a feeling of nausea. This period follows a sharp abdominal pain syndrome in early frankly, not very intense so far, because of widespread pain in the hypogastric predominant "abdomen." This is a permanent pain syndrome without paroxysmal crisis.
The patient reports a little vomiting at the beginning of pain syndrome and a simple and nausea without vomiting. The transit stop was early and absolute, for both materials and gases.
She is not shocked, there is no fever. The review shows a significant bloat, large and asymmetric in the inspection, there is no peristaltic waves; auscultation did not reveal noise-fluid. Palpation found a painless tummy, feeling rénitence, the abdomen is tympanitic on percussion, the hernial orifices are free. Digital rectal examination shows bulging of the anterior wall of the rectum, delivered by an elastic swelling, rectal mucosa was also normal.

B1. Signs of observation, which ones are compatible with the diagnosis of occlusion of the lower large intestine? (CM)
A. Early vomiting.
B. Sudden onset.
C. Early stopping materials and gas.
D. Some abdominal pain.
E. Meteorism important.

B2. The causes of occlusion of the large intestine, which is the one that is least likely? (CS)
A. Sigmoid.
B. Cancer of the sigmoid colon.
C. Volvulus of the pelvic colon.
D. Volvulus of the cecum.
E. Obstruction by gallstone ileus.


B3. Signs of observation, which ones are more in favor of an occlusion of the pelvic colon volvulus as an occlusion of the sigmoid colon cancer? (CM)
A. Sudden onset.
B. Absence of vomiting.
C. Stopping materials and gas early and brutal.
D. Meteorism asymmetrical.
E. Absence of peristalsis.

B4. The radiograph of abdomen without preparation, a sign is characteristic of the pelvic colon volvulus (CS)
A. Images fluid level central and peripheral.
B. Images fluid level peripheral.
C. Images fluid level wider than high.
D. Images multiple fluid levels.
E. Image fluid level large central arch.

B5. It is the diagnosis of pelvic colon volvulus. The following attitudes are acceptable, except one, which one? (CS)
A. Operate without any further examination.
B. Survey by repeated radiographs of the abdomen without preparation.
C. Soluble barium enema followed by surgery.
D. Endoscopy followed by surgery.
E. Rectal probe followed by surgery.



Answers MCQ
Clinical
Small Gut
1- ABCE
2. ABCDF
3. B, C
4. ACEF
5. B
6. ABC
7. A, B.
8. C: 1-2-3
9. E
10. B
11. ACE
12. B
13. BD
14. ABE
15. AC
16. ACD
17. AB
18. AD
19. B
20. D
21. D
22. BD
23. ACE
24. AC
25. ACD
26. E
27. ABDE
28. ACE
29. ABE
30. A

Large Gut
1. B
2. A, B, E.
3. B: 2-3
4. B
5. ABE
6. AB
7. BE
8. ABE
9. AB
10. BDE
11. B
12. BC
13. DE
14. BD
15. BC
16. BCDE

Causes
1- BC
2- ACE
3. ABCDE
4. B
5. A, D
6. AD
7. ABCDE
8. B
9. ACD
10. B
11. ACD
12. D
13. ACE
14. D: 2-4-5
15. E
16 - ABD
17. D
18. ACDEH
19. BE
20. B
21. BCDE
22. BC
23. AC
24. BE
25. B
26. BCDE
27. ACD
28. ACE
29. AD
30. D
31. ABCD
32. A

Investigations
1- C
2. AB
3. D
4. A, B, C,
5. C
6. BC
7. B
8. BDE
9. A
10. C
11. BC
12. A
13. ABD
14. A
15. BCDE
16. ABCD
17. BCDE
18. BD

Complications
19. B

Treatment
1. D
2. B, C
3. B, C

MCQs Intussusception

Clinical
1. B, C, D, E
2. C
3. D
4. C-E
5. ABCDE
6. A
7. D
8. A, C
9. C

Cause
10. B.
11. A B C D E
12. E

Investigation
13. B C D
14. B D.
15. B D.
16. BD
17. ABD

Complication
18. D
Biliary Ileus
1. C
2. D
3. B
4. B
5. B

Clinical case
Clinical case A
A1. ABD
A2. AD
A3. AD
A4. C

Clinical case B
B1. BCDE
B2. E
B3. ADE
B4. E
B5. B