FRCR 2A

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Gastro-intestinal (including liver, biliary, pancreas and spleen)

1. A 65 year old male presents with chest pain. A barium swallow demonstrates strong, repetitive, non-propulsive contractions with intermittent normal peristaltic waves. Several small diverticulae are noted in the mid-oesophagus. The most likely diagnosis is:
		Achalasia
		Scleroderma
		Diffuse oesophageal spasm
		Candidiasis
		Crohns disease

True, Diffuse oesophageal spasm

2. An 80 year old man presents with intermittent dysphagia and an occasional feeling of a foreign body in the mouth. A barium swallow reveals a large, heterogenous filling defect in the oesophageal lumen which doesnâ€™t cause any significant delay in the transit of barium. What is the most likely diagnosis?
		Glycogenic acanthosis
		Oesophageal adenocarcinoma
		Leiomyoma
		Fibrovascular polyp
		Neurofibroma

3. A 36 year old lady undergoes MRI for characterisation of a lesion in segment 2 of the liver. Majority of the lesion is isointense to the liver on T1 imaging and high signal on T2 imaging. The lesion has a central scar which is hypointense on T1 imaging and high signal on T2 imaging. Post gadolinium, most of the lesion enhances in the arterial phase except for the central scar which enhances in the porto-venous phase. A sulphur colloid study is normal. What is this lesion most likely to be?
		Colorectal cancer metastasis
		Haemangioma
		Hepatic adenoma
		Focal nodular hyperplasia
		Gastrinoma metastases

FNHs often have a central scar. FNH and hepatic adenoma can have similar MRI appearances, sulphur colloid radionuclide studies can be used to distinguish the two lesions. FNH usually has normal sulphur colloid uptake due to sufficient Kupffer cells, whereas hepatic adenomas are usually photopaenic lesions.

4. A 47 year old male patient undergoes a CT-KUB. The liver is noted to have a high attenuation value (HU 110). On a subsequent MRI, the liver and spleen are noted to have diffuse low signal on T1 and T2 weighted imaging. What is the most appropriate biochemical test?
		Serum ferritin
		Caeruloplasmin levels
		Philadelphia chromosome
		Blood culture
		Alpha 1 antitrypsin

The most likely diagnosis is haemochromatosis

5. A 60 year old labourer is pyrexial and undergoes abdominal USS. A 10 cm hypoechoic, well defined cyst is seen in the left lobe of the liver. It contains a smaller cyst within it and a small amount of calcification within the cyst wall. What is the most likely organism?
		Echinococcus Granulosus
		Schistosomiasis Mansoni
		Mycobacterium Tuberculosis
		Ascariasis Lumbroides
		E Coli

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