a. CT scan
b. ERCP
c. MRCP
d. FBC
e. USS of abdomen
2. Regarding gallstones
a. Calcium bilirubinate is the predominant constituent of the mixed stones
b. Pigment stones are caused due to haemolytic anaemia
c. Majority of stones are radiolucent
d. Majority of stones are pigment stones.
e. Majority are of mixed type
3. A 50 year old otherwise healthy male presented with recurrent, vague upper abdominal pain which was worsening after meals. He had lost 5 kg during last 2 months. USS showed multiple stones in gallbladder with mild thickening of the gallbladder wall. Extrahepatic ducts looked normal. No pericholedochal fluid. What is the next appropriate step of management?
a. ERCP
b. ESWL
c. Laparoscopic cholecystectomy
d. MRCP
e. UGIE
4. 45 year old female in routine USS Scan found 4cm solitary stone in gall bladder;
a. Most likely is a pigment stone
b. Acute cholecystitis is likely to occur
c. Requires regular USS to monitor size of the stone
d. Is at an increased risk of malignancy
e. Should undergo Cholecystectomy to prevent complications
5. In a 50 year old man with gall stone disease who is otherwise healthy, the indications for cholecystectomy are
a. History of biliary colic
b. Passage of flatus after meals
c. History of recurrent epigastric pain
d. Porcelain gall bladder
e. Serum cholesterol level of 425mg/dl
6. T/F regarding ascending cholangitis
a. Considered as DD in patient presenting with collapse
b. Caused by stone impacted in cystic duct
c. Common bile duct stone obstruction is relieved by endoscopy
d. Lead to liver abscess
e. Usually caused by gram + organisms
7. 45 year old male presented with yellowish discolouration of eyes & pruritus for 2/52 which progressed gradually. 2/52 prior to presentation he noticed stools were tarry. On examination slightly pale, deeply icteric. The abdomen slightly distended, liver palpable 4cm below the costal margin. The gall bladder is palpable & non tender. The most likely diagnosis
a. CBD calculus
b. CA head of the pancrease
c. Hilar cholangio CA
d. Duodenal CA
e. Periampullary CA
8. 40 year old female presented with right hypochondrial pain for 3 days duration with moderate fever. What features in this history most help distinguishing acute cholangitis from acute cholecystitis?
a. Family history of haemolytic anaemia
b. LOA
c. Passage of tea coloured urine
d. Past history of biliary colic
e. Radiation of pain to back
9. 30yr old male patient presented with progressive jaundice and darkening of urine. USS revealed dilated intrahepatic and common hepatic ducts. But CBD measured 7 mm.GB is not dilated and no GB calculi.What is the most appropriate management?
a. Pecrutaneous transhepatic cholangiogram
b. Contrast enhanced CT
c. MRCP
d. ERCP
e. HIDA
10. 60yr old male with Hx of progressive jaundice going to have a CECT, his RFT are marginally elevated. Which of the following agent/fluid is needed to use during procedure
a. 0.9% NS
b. NaHCO3
c. N-AC
d. IV hydrocortisone
e. N/2 + 5% Dextrose
11. A 60y old male presents with loss of appetite and loss of weight for 6 months. He is deeply icteric and USS of abdomen shows dilatation of intrahepatic ducts but no dilatation of cystic duct or gall bladder, What is the most probable diagnosis?
a. Peri-hilar cholangiocarcinoma
b. Pancreatic head carcinoma
c. Peri-ampullary carcinoma
d. Cholangiocarcinoma of distal CBD
e. Malignant stricture of CBD
12. 65 year old man presented with worsening jaundice & pruritis for 2months, also has anorexia & loss of weight for 4 months. USS gallbladder not distended & has multiple gall stones. CBD not dilated but intrahepatic duct dilated. S.Bilirubin 220umol/, S.Alkaline phosphate -- 1250. What is the diagnosis
a. Common bile cut stone
b. Hilar cholangio CA
c. Mirizi syndrome
d. Periampulary CA
e. Sclerosing cholangitis
13. Which of the following is not a recognized cause of postoperative jaundice following laparoscopic cholecystectomy?
a. Ascending cholangitis
b. Ligation of the left hepatic duct
c. Ligation of the common hepatic duct
d. Gallstone retention in the common bile duct
e. Thermal injury due to use of electrocautery during dissection.
14. Operations that require perioperative use of antibiotics in otherwise healthy patient include
a. Herniotomy repair in a 3yr old baby
b. Thyroidectomy
c. Elective left hemicolectomy
d. Transurethral resection of prostate
e. Knee joint replacement
15. Which of the following is not a risk factor for gallstone formation?
a. Smoking
b. Pregnancy
c. Crohn's disease
d. Diet high in fats
e. Contraceptive pills
16. Laparoscopic cholesystectomy is contraindicated in,
a. Acute cholecystitis
b. Large solitary gallstone
c. Empyema of the gallbladder.
d. Patient with bleeding disorder
e. Carcinoma of the gallbladder
Answers
01. e
02. a) F b) T c) T d) F e) T
03. c
04. a) F b) F c) F d) T e) F
02. a) F b) T c) T d) F e) T
03. c
04. a) F b) F c) F d) T e) F
05. a) T b) F c) F d) T e) F
06. a) T b) F c) T d) T e) F
07. e
08. c
09. c
10. a
11. a
12. c
13. a) F b) T c) F d) F e) F
14. a) F b) F c) T d) T e) T
15. a) T b) T c) T d) T e) T
16. a) F b) F c) F d) T e) T
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