MCQS 1.

The best root for nutrition in a stroke patient who requires feeding for more than four weeks is a. feeding jejunostomy b. TPN c. Percutaneous endoscopic gastrostomy feeding d. nasogastric feeding 2. A 45 year old obese man is undergoing laproscopic cholecystectomy. The abdomen has been rapidly insufflated with Carbon di oxide. The anaesthetist alerts you to a sudden and rapid drop in blood pressure and increase in heart rate.This event occurred most likely due to a.Carbon di oxide embolus b. pneumothorax c. reduced venus return d.respiratory compromise 3. A 56 year old woman presents with a two weeks history of increasing jaundice and pruritis. Further questioning reveals that she has vague epigastric pain radiating to the back for last few months.On examination gall bladder is palpable with no obvious hepatomegaly.The most likely diagnosis is a. cholangiocarcinoma b. pancreatic carcinoma c. carcinoma of gal bladder d. hepatocellular carcinoma 4. A 60 year old man presents to the emergency department with a three weeks history of right upper quadrant pain, weight loss and abdominal distension.Examination reveals jaundice, a nodular and enlarged liver and presence of shifting dullness. The most likely diagnosis is a. hydatid disease

b. liver abscess c. HCC d. cirrhosis of liver 5. A 42 year old woman complains of left side chest and abdominal pain, worse on respiration on 7 th post-op day of splenectomy,Examination reveals temperature of 38.6 C,decrease air entry and left upper quadrant tenderness. Which complication of splenectomy comes in your mind a. subphrenic abscess b. basal atelectasis c. gastric perforation d.pancreatic fistula 6. A 60 year old woman presents with a two day history of vomiting and colicky central abdominal pain.Her abdomen appears mildly distended. Abdominal film shows dilated small bowel and air in the biliary tree.The most likely diagnosis is a.cronhns disease b. volvulus c. gallstone ileus d.diverticular disease e. emphysematous gall bladder 7. A 27 year old man presents with a 7 days history of abdominal pain which radiates through to the back,He has been vomiting conituously for last 2 days and has been unable to take any fluid.His bowels open regularly with no history of stetorrhoea. There is no history of similar episodes in the past. On examination he is pale dehydrated and has marked tenderness in epigestric region. The most likely diagnosis is a.Ac. cholecystitis b. Ac. pancreatitis c. Ch. cholecystitis

d. cystic fibrosis e. perforated deuodenal ulcer 8. The treatment of choice for a patient who presents with worsening pain in right upper quadrant associated with nausea and vomiting. She is neither clinically nor bio chemically jaundiced but is febrile.An ultrasound reveals gall stones, thickening of gall bladder wall and common bile duct diameter of 5 millimeter. a. open colecystectomy b. laproscopic colecystectomy c. interval laproscopic colecystectomy d. percutaneous gall bladder drainage 9. The treatment of choice for a 80 years old diabetic patient, who presents with a 3 days history of progressive right upper quadrant pain. On examination he is septic and has a tender mass in right upper quadrant. White cell count is 21,000 a. . percutaneous gall bladder drainage b. ERCP and sphincterotomy c. open colecystectomy +CBD exploration d. early laproscopic colecystectomy 10. The management plan for a 45 years old woman who presents with a 2 days history of right upper quadrant pain, rigors nausea and vomiting. She is febrile and has yellowish discoloration of body. Ragarding liver function test, belirubin and alkaline phosphatase are markedly raised.Ultrasound demonstrates a CBD diameter of 14 mm with multiple stones present. a. ERCP and sphincterotomy b. early laproscopic colecystectomy + per operative cholangiography c. laproscopic colecystectomy +CBD exploration d. open colecystectomy +CBD exploration 11.

Nutritional impairment is present when BMI is below a.22 b. 20 c. 18 d. 16 12.For TPN, the preferred vain is a. vein on fore arm b. vein on anticubital fossa c. right subclavian vein d. left subclavian vein e. Internal jugular vein 13.The common symptoms and signs of cholangitis are all except a. biliary colic b. fever and chills c. jaundice d. obliterated biliary channels in US 14. Diagnosis of hydrated liver disease is by all except a.US b. CT scan c. needle aspiration d. casonis skin test 15. To exclude onset of HCC in cirrhotic liver the test of choice is a.US

b. CT c. Alpha fetoprotein d. none of above 16. Kehr sign in splenic trauma refers to a.pain and hyperaesthesia in left shoulder b. pain and hyperaesthesia in right shoulder c. bruising around left 10th and 11th ribs d. hiccup and haemoptysis on leg elevation 17. A young child having enemia, amnd gall stones should be investigated for a.cystic fibrosis b. congenital spherocytosis c. malaria d. primary sclerosing cholangitis 18. Gall stones are radioopaque in a.5 % b. 10% c. 20% d. 40% 19. The primary investigation of choice in gall stone disease is: a.plain X-ray b. CT scan

c. USG abdomin d. radionuclide scan e. MRCP 20. Pancratitis is best diagnosed from a. serum amylase b. amylase clearance c. CT scan d. Symptomatology alone 21. A 25 year old obese woman who denies any history of alcohol intake presents with severe abdominal pain radiating to back.Labortory results indicate an increase in serum amylae and lipase with marked decrease in serum calcium, which of the following has likely caused this condition a.alcohol b. cystic fibrosis c. mumps d. cholelithasis 22. All of the following are true for entral root of nutrition except: a.may cause bacterial over growth in gut b. reduces stress ulceration c. is less expensive than TPN d. decreases the incidence of cholestasis by promoting biliary flow. 23. The most significant presentation of carcinoma of body of pancreas is a. pain

b. weight loss c. anorexia d. jaundice 24. A 67 year old woman is evaluated for obstructive jaundice.The cholangiographic findings indicate that she has a cancer of the lower end of the CBD. Clinical examination would most probably reveal which of the following a.enlarged gall bladder b. shrunken gall bladder c. enlarged pancreas d. shrunken pancreas e. palpable tumer 25. The investigation of choice in acute cholecystisis is a.US b. oral cholecystography c. radionuclide scan d. none of above 26. A 45 year old male is suspected of having an amebic abscess of the liver.Serum bilirubin is mildly elevated.The WBC is 11,000 but there is eosinophilia.The initial line of treatment involves which of the following: a.cortisone b. metronidazole c. surgical excision d. sulfonamides and penicillin e. colon resection

27. Normal saline contains all of the following except: a.water b. 150 mille mole per liter sodium c. 150 mille mole per liter chloride d. 20 mille mole per liter potassium 28. A 60 year old man is admitted to hospital with adiagnosis of acute cholecystitis .The WBC count is 28,000 and a plain film of abdomen and CT scan shows evidence of intramural gas in the gall bladder. What is the most likely diagnosis? a. emphysematous gallbladder b. acalculous cholecystitis c. Sclerosing cholangitis d. gallstone ileus 29. A 70 year old male presents with a clinical diagnosis of acute cholangitis. What organism is most likely involved in the pathogenesis of ascending cholangitis? a. colonorchis sinensis b. escherichia coli c. clostridia d. ataphylococcus aureus 30. The classic triade of pain right hypochondrium, fever with rigor and chills and jaundice is known as: a.callots triade b. chaorts triade c. saints triade d. virchows triade