Q. Which is not true of acute appendicitis?

A. Urine pregnancy test should be done in females

B. Presence of pyuria rules out appendicitis

C. Acute intermittent porphyria may mimic it

D. Diabetic ketoacidosis can present with abdominal pain

Answer B

1. Urine analysis is useful when evaluating people with appendicitis

2. Mild pyuria can occur in patients with appendicitis because of relationship of the appendix with the right ureter

3. Proteinuria and hematuria are usually associated with urological or hematological disorders

Q. Which is false about mesenteric adenitis?

A. Caused by rotavirus

B. Produces fever

C. Can be confused with appendicitis

D. May cause WBC elevation

Answer A

1. Mesenteric adenitis is most frequently caused by viral pathogens, but other infectious agents have been implicated, including Yersinia enterocolitica, Helicobacter jejuni, Campylobacter jejuni, and Salmonella or Shigella species

2. An association with streptococcal infections of the upper respiratory tract, particularly the pharynx, has been reported

3. Patients with mesenteric adenitis may have RLQ pain or generalized abdominal pain

4. Free air is not a feature of the illness. Voluntary guarding and rectal tenderness are also common features

Q. Which is not true of Crohn Disease?

A. X-ray findings may mimic diverticulitis

B. Has a “saw tooth” appearance on barium enema

C. Entero-cutaneous fistulas are common

D. Surgery is curative

Answer D

1. Surgery (resection of parts of the bowel) is avoided, as this does not cure the disease –Crohn disease can recur at any site in the digestive tract

2. 50% of all Crohn patients eventually undergo one or more resections to control highly active disease. Most often, this is in the terminal ileum

3. In some cases of widespread intractable Crohn colitis, removal of the colon and rectum (protocolectomy) is required. In these cases, the patient is left with an ileostomy

Q. Which is false about liver abscess?

A. Gram-negative bacteria are common cause

B. Hiccups may occur

C. Can lead to jaundice

D. Amebic liver abscess is usually most common in left lobe

Answer D

1. The right hepatic lobe is more commonly affected than the left lobe by a factor of 2:1

2. Bilateral liver involvement is rare

3. The predilection for the right lobe is due to blood from the SMV and portal veins, whereas the left lobe receives IMV and splenic drainage

Q. The most common cause of liver abscess today is:

A. Appendicitis

B. Biliary tree disease

C. Hydatid infections

D. Trauma

Answer B

1. Biliary tract disease is the most common cause of pyogenic liver abscess

2. Obstruction of the bile flow allows bacteria to multiply

3. Biliary disease like strictures, congenital obstructions, or malignancies can cause pyogenic liver abscess