Quiz

Question :1 Ideal preferred treatment for carcinoma of the gallbladder in majority is:

Radical resection that includes gallbladder in continuity with the right hepatic lobe and regional lymph node dissection.
Radiation therapy.
Radiation therapy.Chemotherapy.
Radiation therapy.Chemotherapy.Palliative

Question :2 Which of the following statements about the segmental anatomy of the liver are not true?

Segments are subdivisions in both the French and American systems.
Segments are determined primarily by the hepatic venous drainage.
French anatomic system is more applicable than American system to clinical hepatic resection.
Segments are important to the understanding of the topographic anatomy of the liver.

Question :3 Auxillary orthotopic liver transplant is indicated donor

Metabolic liver disease
As a standby procedure until finding suitable donor
Drug induced hepatic failure
Acute fulminant liver failure for any cause

Question :4 All the following are associated with poor outcome after repair of Benign Bilairy stricture EXCEPT

Type 3 BBS
Early repair
External biliary fistula
End to end biliary anastomosis

Question :5 Ideal preferred treatment for carcinoma of the gallbladder in majority is:

Radical resection that includes gallbladder in continuity with the right hepatic lobe and regional lymph node dissection.
Radiation therapy.
Chemotherapy.
Palliative

Question :6 All of the following statements about the physiology of esophagus are true except:

Primary peristaltic contractions are progressive & move down esophagus at rate of 2-4 cm/sec and reach LES about 9 seconds after the initiation of swallowing.
Tertiary contractions are nonprogressive, monophasic or multiphasic simultaneous waves that occur after voluntary swallowing or spontaneously between swallows throughout esophagus.
Secondary peristaltic waves are mostly non progressive and are generated by the esophageal distension or irritation.
Primary peristaltic waves generate an intraluminal pressure of 40-80 mm Hg.

Question :7 All the following statements about the microscopic anatomy of stomach are true except:

Endocrine G cells are located in greatest quantity in the antral glands.
In cardia of stomach, the mucosa is arranged in branched glands and the pits are short.
Gastric glands are more tubular and the pits are longer in the fundus and corpus of stomach.
Glands in the antrum of the stomach are less branched and have abundance of parietal cells.

Question :8 Following areas of the liver are not invested by peritoneum except:

GB fossa
Porta hepatis
Posterior aspect of liver to the right of IVC
Along the falciform ligament of liver

Question :9 Not true about Paget’s disease of the anal canal is:

It is a rare intraepithelial adenocarcinoma in an area of squammous epithelium.
It has been proposed to be derived from pluripotent epidermal stem cells.
More common in younger individuals and associated with an underlying carcinoma in 50-86% of patients.
Presence of PAS positive Paget cells confirms the diagnosis

Question :10 All of the following statements about tuberculous peritonitis are true except:

In the ascitic form of TB peritonitis, the patients is usually brought into attention because of rapid enlargement of the abdomen despite being relatively pain free.
Laparotomy is often performed in the encysted form of TB peritonitis in a child because of diagnostic confusion with a mesenteric cyst.
In purulent form of TB peritonitis, a cold abscess may often form and points on the surface, commonly near the umbilicus.
Hyperplastic form of TB peritonitis is synonymous to the purulent form and usually occurs secondary to TB salpingitis.

Question :11 Correct order of reconstruction in the recipient in OLT by the piggy back method is:

Bile duct, Hepatic artery, Suprahepatic IVC, Infrahepatic IVC & Portal vein
Suprahepatic IVC, Hepatic artery, Portal vein & Bile duct.
Hepatic artery, Bile duct, Portal vein & Suprahepatic IVC.
Suprahepatic IVC, Infrahepatic IVC, Hepatic artery, Portal vein & Bile duct.

Question :12 Not a component of Chinese university prognostic index (CUPI) scoring system for HCC:

Serum bilirubin
TNM stage.
Serum albumin.
Serum ALP.

Question :13 A replaced left hepatic artery arises from:

Left gastric artery.
Celiac trunk.
Superior mesenteric artery.
Common hepatic artery.

Question :14 Not a true statement about extraintestinal manifestations of IBD is

Erythema nodosum occurs in 10-15% of patients with ulcerative colitis and often occurs in conjunction with peripheral arthropathy, showing remarkable response to surgical management of UC.
Pyoderma gangrenosum presents most commonly on the thigh and lower trunk as pustular painful eruptions, usually in the setting of active IBD.
PSC occurs in 5% to 8% of patients with UC, mostly in younger men.
Risk of colon cancer in patients with concomitant PSC is about 5 times more than that with UC alone, mostly presenting proximal to splenic flexure.

Question :15 Following procedure carries the maximum rate of esophageal perforation:

Dilatation of malignant lower esophageal stricture.
Pneumatic dilation of achalasia cardia.
Dilation of reflux lower esophageal stricture with Savary-Gillard dilator system.
Balloon dilation of dilatable corrosive strictures.

Question :16 All the following statements about serous cystic neoplasm of pancreas are true except:

SCNs are more commonly seen in women with an average age at diagnosis of 62 years.
Most SCNs are located in the body and tail of pancreas.
Cysts are lined by a uniform layer of cuboidal, glycogen rich serous cells with round nuclei and clear cytoplasm.
SCN in a 60 year old with a size of 5 cm along the largest axis should be taken up for resection.

Question :17 Mark the correct option:

All are true.
i,ii,iii,iv are true.
i, ii and iii are true.
i,ii,iv are true.

Question :18 A 40 year old smoker male presents with complaints of frequent episodes of heartburn and difficulty in swallowing chicken pieces in diet. He also gives a history of frequent impaction of solid food in the recent past. His brother is a known asthmatic on regular salbutamol inhaler. What will be the expected endoscopic finding(s) in this patient?

Non circumferential erosions with overlying exudates.
Vertical furrows and 1-3 mm white specks with a small caliber esophagus.
Normal esophageal mucosa.
Polypoidal growth in the lower thoracic esophagus nearly obstructing the lumen.

Question :19 A 45 year old male presented with progressive jaundice over the past 3 mths with weight loss and passage of clay colored stools. CECT abdomen showed the following. Structures marked by the arrow clockwise from the right to left are:

Mass from head of the pancreas, portal vein, splenic vein.
Dilated CBD, periampullary mass, dilated pancreatic duct
Mass from periampullary region, portal vein, splenic vein.
Mass from periampullary region, splenic vein, pancreatic duct.

Question :20 Not true about Schilling test for malabsorption is:

Normal stage 1 test shows atleast 10% of radiolabelled vitamin B12 in urine over 1st 24 hrs.
The second stage of the test is done with addition of castle’s intrinsic factor.
Third stage of schilling test is useful for identifying patients with chronic pancreatitis.
Cases of intestinal lymphangiectasia may give a normal result on schilling test.

Question :21 Most common location of hemangioma in small bowel is:

Duodenum.
Jejunum.
Ileum.
All have equal distribution.

Question :22 Which branch of portal vein is usually involved in chronic pancreatitis?

Superior mesenteric vein
Splenic vein
Left branch of portal vein
Inferior mesenteric vein

Question :23 Not true about wandering spleen is

Chronic torsion leads to splenomegaly
Treatment of choice is splenectomy only
Infarction & torsion are common
Encapsulated with Long vascular pedicle

Question :24 All are true about retained antral syndrome except

Tech 99 scan is used for diagnosis
Seen after bilroth II surgery
Positive pentagastrin test
Calcium provocation test was negative

Question :25 All of the following statements are true about post gastrectomy syndromes except:

Basic defect of late dumping syndrome is rapid gastric emptying and it is related specifically to carbohydrates being delivered rapidly into the proximal intestine.
Megaloblastic anemia develops independent of amount of stomach removed.
Bilious vomiting offers an immediate relief of symptoms in case of afferent loop syndrome.
More than 50% of the cases of efferent loop obstruction post gastroenterostomy occur within first postoperative month.

Question :26 All the following statements about post Ulcerative colitis colonic strictures are true except:

Colonic strictures can occur in 5% to 12% of patients with chronic UC.
60% of the strictures with malignant potential appear after 20 yrs versus 0% before 10 yrs
Most of the strictures with suggestive malignant potential are located distal to splenic flexure with 10-20% being malignant.
Histology mostly shows hypertrophy of the muscularis propria.

Question :27 Gall bladder carcinoma is M1 stage when which of the following lymph nodes are involved?

Superior mesenteric lymph nodes
Aortic lymph nodes
Celiac lymph nodes
Pancreato-duodenal lymph nodes

Question :28 Critical window of Strassberg in laparoscopic cholecystectomy aims at visualization of:

Segment IVb and V.
Segment V.
Cystic artery.
Cystic lymph node of Lundh.

Question :29 All of the following are indications of diagnostic laparoscopy in a patient with carcinoma pancreas except:

Tumor located in the head of the pancreas.
Tumor size 4 cm.
CA 19-9 level 200 U/mL.
Inconclusive findings on CECT abdomen.

Question :30 Half life of CCK is:

2-3 mins.
20-30 mins.
2-3 hrs.
20-30 hrs.

Question :31 All of the following are true about Sphincter of Oddi dysfunction except:

As per Milwaukee diagnostic classification, the pancreatic duct should be greater than 10 mm for a diagnosis of pancreatic type SOD.
For type II SOD, manometry is recommended.
Type III shows around 10% response to treatment, even if the manometry is normal.
Type I SOD shows a 90-95% response to treatment even in setting of abnormal manometry.

Question :32 All of the following findings on clinical and biochemical analysis are suggestive of acute alcoholic hepatitis except:

Marked elevation of GGT.
Elevated levels of serum IgA.
Low TLC.
Hepatomegaly.

Question :33 All the following statements about the pathogenesis of amoebic liver abscess are true except:

Trophozoite adhesion to colonic wall is mediated by lectin, resulting in caspase 3 activation.
Amoebapores result in osmotic lysis of the cell.
Cysteine proteases lead to degradation of ECM proteins and disruption of cell monolayers.
Step most crucial to necrosis and abscess formation is the one mediated by cysteine proteases.

Question :34 Most common heterotopic tissue found in liver parenchyma is:

Kidney.
Adrenal.
Pancreas.
Spleen.

Question :35 All of the following factors have been implicated to contribute to hepatic tolerance except:

Immunosuppression via release of soluble MHC class I antigens.
Microchimerism.
Constant antigen load from the portal circulation.
Inhibition of T cell mediated apoptosis.

Question :36 Which of the following patients would most likely benefit from robotic-assisted versus laparoscopic surgery or colorectal cancer

A 75 year old admitted with a lower gastrointestinal bleed, ound to have a bleeding cecal tumor on colonoscopy
A 60-year-old man with a low rectal cancer Abutting prostate on EUS
A 64-year-old man with no significant medical history with a descending colon mass
A 55-year-old man admitted with obstipation with obstructing sigmoid tumor

Question :37 Which of the following have not been used in chromoendoscopy of esophagus

Potassium iodide
Cresyl violet
Congo Red
Methylene blue

Question :38 Which of the following splenic ligaments is not avascular

Gastrosplenic
Splenocolic
Phrenosplenic
plenorenal

Question :39 In Carcinoma head of pancreas, Nausea & vomiting is due to

External Compression of duodenum
Portal vein infiltration
Proliferation infiltration of tumor into duodenum
Chemotherapy related

Question :40 According to AJCC 8th edition, Staging of 2cm size Pancreatic cancer if it involves portal vein is?

T1
T2
T3
T4

Question :41 True about Visceral aneurysm is

Splenic artery is commonly involved
Hepatic aneurysm is operated irrespective of symptoms
Splenic artery aneurysm is most commonly followed by trauma
True aneurysms are more common nowadays with increasing abdominal trauma

Question :42 False about Pseudomyoxma peritonei is

Recurrence after surgery
Refractory to drugs
Hyperthermic intraperitoneal chemotherapy is treatment option
Most commonly associated with appendiceal tumour

Question :43 True about Splenunculi

Encapsulated
Most common site is tail of pancreas
Often single
More red pulp than spleen

Question :44 When to do surgery in case of Pancreatic ascites?

Symptomatic
Recurrent ascites following abdominal drainage
Not responding to medical therapy
Leak from the stented duct

Question :45 Liver tunneling procedure not done for which segment?

I
IV
V
VIII

Question :46 A 55-year-old male patient with gastritis symptoms diagnosed to have gastric ulcer for which he had undergone partial gastrectomy three years back and currently on high dose omeprazole. Follow up endoscopy reveals two ulcerative lesions in gastric mucosa.What is the next step in management?

H.pylori serology
Insulin tolerance
Gastrin level
CT scan

Question :47 Saw tooth appearance in abdominalbarium enema X-ray:

Multiple polyposis
Prediverticulosis
Ischemic colitis
Ulcerative colitis

Question :48 Scalloping of edge of sigmoid colon seen in:

Diverticulitis
Ulcerative colitis
Grahn's disease
Sigmoid volvulus

Question :49 Following esophagus perforations, non-operative treatment methods are preferred in all except:

Mediastinum involvement
Cervical perforation
Boerhaave syndrome
Perforation caused by fiberoptic endoscopy

Question :50 High fiber diet reduces risk of the following except:

IBD
Carcinoma colon
Sigmoid volvulus
Diverticulitis

Question :51 Barium meal characteristic feature of malignant gastric ulcer is:

Hampton line
Carmen meniscus sign
Ulcer cap
Ulcer crater

Question :52 Hereditary pancreatitis is characterised by all except:

80% penetrance
30% leads to chronic pancreatitis
Autosomal recessive inheritance
Pancreatic cancer risk is high

Question :53 Early complication of TIPS procedure:

Shunt stenosis and blockage
Capsular haemorrhage
Metabolic encephalopathy
Recurrent variceal bleed

Question :54 Treatment of choice for simple cyst of liver:

Percutaneous drainage
Cysto Enterostomy
Deroofing
Aspiration

Question :55 Best method to visualise the proximal bile duct is by:

Percutaneous transhepatic cholangiogram
EUS
ERCP
Transabdominal USG

Question :56 A 70 years old male came with complaints of pain in the right hypochondrium. On examination the patient had a mass abdomen in the right upper quadrant. Ultrasound of the abdomen done which showed a 10 × 10 cm mass in the right lobe of liver. Which of the following tumor marker would be helpful?

CA 19-9
ALP
AFP
Calcitonin

Question :57 Which of the following can differentiate mechanical small bowel obstruction from paralytic ileus?

Increase in the level of hemidiaphragm
Dilated bowels
Multiple air fluid levels
Absence of rectal gas shadow

Question :58 Which of the following is not true regarding Meckel’s diverticulum?

Distance from ileocecal valve depends on patients age
Blood supply is from omphalomesentric artery which is a branch of superior mesenteric artery
It is found on the mesenteric border of the intestine
Most common ectopic mucosa found is gastric mucosa

Question :59 In alcoholic suffering from cirrhosis with portal hypertension, which shunt will maintain a Physiological flow?

Warren shunt
Proximal splenorenal shunt
Mortex shunt
Inokuchi shunt

Question :60 What is modified radical gastrectomy?

Spleen & Pancreas removed
Gastrectomy with N1 nodes removed
Gastrectomy with N2a nodes removed
2a lymph node removed except splenic hilum

Question :61 True statement regarding choledochal cyst are all except:

Type 2 is most common
It is a premalignant condition
Surgical excision is the treatment of choice
Associated with anomalous union of pancreatic and bile duct.

Question :62 Which of the following is true regarding femoral hernias

Watchful waiting or surgical repair are both reasonable options to consider in otherwise healthy patients diagnosed with asymptomatic femoral hernia.
Mesh plug repair is the pre erred approach in emergent cases.
Rate of incarceration and strangulation is reported as greater than 40%.
Men are more likely than women to experience this type of hernia.

Question :63 Ulcerative colitis differs from Crohn’s disease by the following features

Rectum is always involved
Granuloma formation
Strictures are more common
Associated with perianal lesions

Question :64 Which of the following is largely restrictive & mildly malabsorptive

Roux-NY Gastric bypass
Vertical band gastroplasty
Duodenal switch
Laproscopic sleeve gastrectomy

Question :65 A 62-year-old male with a history of diverticulitis presents with pneumaturia,urinary frequency and dysuria for several days. He is afebrile and hemodynamically stable. Urine culture grows multiple organisms. For this patient the definitive management consists of:

Total parenteral nutrition, bowel rest, and antibiotics
Colon resection with primary closure Of bladder
Colon resection and excision Of cuff Of bladder
Partial cystectomy