1. Regarding to gallstone is/are true except:

A. The gallstone is less common in fair skin females.B. Bile constituents can be found in every types of gallstone.C. Pigment gallstone is most commonly found in the common biliary duct.D. Cholesterol supersaturation in the gallbladder can be influenced by pH value of the gastric

emptying.E. Cholesterol stone is large in size and solitary.

2. These statement is true about gallstones:

A. Cholesterol stone can be dissolved spontaneously through medical regimens.B. Pigment tones can be caused by excessive packed red blood cell transfusion.C. One of the gallstones complications is intestinal ileus as a result parasympathetic stimulation.D. Acute cholecystitis is always secondary to infected gallstones.E. Production of urease by Escherichia Coli will cause bile acid supersaturation.

3. Following these statements is/are true about Acute Pancreatitis except:

A. The presentations of Acute Pancreatitis can mimick the Dengue Shock SyndromeB. The common abdominal pain in Acute Pancreatitis is boring pain.C. The differential diagnosis for Acute Pancreatitis includes liver abscess and ascending cholangitis.D. Cullen sign is defined as hemorrhagic discoloration of the paraumbilicus.E. Periampullary tumor is one of the causes of Acute Pancreatitis.

4. All these statements are true about Acute Pancreatitis:

A. Spontaneous Bacterial Peritonitis (SBP) is the complication of Acute Peritonitis.B. Gallstone present in the Ampulla of Vater can predispose to develop Chronic Pancreatitis.C. Methanol cannot cause Acute Pancreatitis.D. Excessive drinking of alcohol is the least common cause of Acute Pancreatitis.E. MRCP is one of the predisposing factors to develop Acute Pancreatitis.

5. Patho-clinical changes in Acute Pancreatitis:

A. Acute Pancreatitis can cause calcium fatty necrosis.B. There are no specific biochemical tests to diagnose Acute Pancreatitis.C. Abdominal roentgenogram will show sentinel loop dilatation of the colon.D. Serum lipase will be raised first and it is lasts longer compared to the amylase.E. CT abdomen is necessary to differentiate Acute Pancreatitis from other serious intra-abdominal

condition including perforated ulcer.

6. Acute Pancreatitis can be diagnosed through:

A. Modified Ranson Criteria is currently used as diagnostic criteria for Acute Pancreatitis.B. Modified Ranson Criteria and APACHE II can be used as prognostic prediction for Acute

Pancreatitis.C. Serum Alanine Transaminase (ALT) should be more than 250 IU/L.

D. Ranson cruiteria still reliable after 48 hours patient’s presentation with Acute Pancreatitis.E. Urea level is one of the components in Ranson Criteria.

7. Regarding gallstones;A. Gallstone colic is a moderate pain caused by spasm of gallbladder.B. Pigment stones consist of calcium bilirubinateC. Courvoisier’s law states if the gallbladder is palpable in the presence of jaundice, the jaundice is

likely due to stonesD. Cholesterol stones can develop in women whom taken oral contraceptive pillsE. Existence of fistulous tract from gallbladder with stomach may predispose to gallstone ileus

8. Concerning pancreatitis;A. It can be due to hypocalcemiaB. Cullen’s sign is bruising in the flankC. Calcium higher than 2 mmol/L is a feature of severe pancreatitisD. Oxygen less than 7.98 kPa is a feature of severe pancreatitisE. TWCC higher than 16 x 109/L is a feature of severe pancreatitis

9. The statement below describes about pancreatic tumourA. Most are benignB. Periampullary carcinoma can be treated by a pancreaticoduodenotomyC. Glucagonoma causes hypoglycaemiaD. Zollinger - Ellison syndrome is associated with recurrent peptic ulcerationE. Carcinoma is associated with thrombophlebitis migrans

10. Concerning cholelithiasisA. Over 10% are calcifiedB. Are common in patients with haemolytic disordersC. Charcot’s triad is associated with acute cholecystitisD. Gallstones increase the risk of bleeding disordersE. They are associated with squamous cell cancer of gallbladder

11. Features of obstructive jaundice includeA. Pruritus caused by bile pigmentsB. Increased alkaline phosphataseC. Prolonged clotting timeD. Normal calibre bile ducts on ultrasoundE. Risk of renal impairment

12. Portal hypertensionA. Develops if the portal pressure ids over 5 mmHgB. Can be associated with schistosomiasisC. Can cause thrombocytopeniaD. Predisposes to the development of rectal varicesE. May be relieved by a transjugular intrahepatic shunt (TIPS)

13. Regarding hepatic tumoursA. Primary hepatocellular carcinoma is very common worldwide

B. Carcinoembryonic antigen is associated with hepatomaC. Aflatoxin are common cause of hepatoma produced by Aspergillus flavusD. Are associated with the use of oral contraceptives E. Metastatic tumour are an unusual cause

14. Below are the risk factors for gallstonesA. FemaleB. BMI < 23C. Postmenopausal womenD. Age > 40 yearsE. Vegetarian

15. Cystic duct stonesA. Follows the Courvisier’s law B. Can develops mucoceleC. Patient presents with obstructive jaundiceD. Empyema is a known complicationE. It is not removable

16. Portal hypertensionA. Budd-Chiari syndrome is the cause of pre-sinusoidal obstructionB. Patient can have exudative ascitesC. Bleeding from the caput medusae is commonD. Esophageal varices can mimicked PUDE. Can cause pancytopenia

17. Causes of acute pancreatitisA. CholedocholithiasisB. AlcoholismC. Penetrating abdominal injuryD. Post-ERCPE. NSAIDs

18. Liver cirrhosisA. Is a reversible conditionB. Characterized by fibrosis of the hepatic lobule with distortion of the normal architectureC. Curative treatment is liver transplantD. Patient presents with stigmata of chronic liver diseasesE. Can lead to HCC

19. The sphincter of OddiA. is contracted by cholecystokinin (CCK)B. regulates the flow of bile into the duodenumC. relaxes in response to gastrinD. contracts in the interdigestive period

20. Bile

A. contains only water, bile acids and cholesterolB. contains unconjugated bile acidsC. contains conjugated bilirubinD. is required for the uptake of protein in the small intestineE. is required to help emulsify fats in the stomach

21. Cullen’s sign may be seen in :A. Cushing’s syndromeB. Acute pancreatitisC. Hirchsprung’s diseaseD. Carcinoma of the pancreasE. Peritonitis

22. Haemochromatosis is characterized byA. yellow discoloration of the skinB. Diabetes Mellitus resulting from insufficient insulin productionC. Liver enlargementD. A genetic defect on chromosome 6E. Saturation of the iron binding lactoferrin

23. The causes of acute pancreatitis include :A. Post-ERCPB. AzathioprineC. AlcoholD. NSAIDSE. Gallstones

24. Regarding the pancreas;A. ectopic pancreatic tissue may be found in the distal end of the oesophagusB. Ranson’s criteria are used to stage chronic pancreatitisC. Speckled calcification of pancreas may occur in chronic pancreatitisD. Pseudocysts are usually multipleE. Diabetic smokers have an increased risk of develop carcinoma head of pancreas

25. The following are potential complications of gallstonesA. acute pancreatitisB. pancreatic cancerC. ascending cholangitisD. primary biliary cirrhosisE. empyema of gallbladder

26. The followings is/are true of tumours of the liverA. metastases are the commonest tumours seen in the liverB. cirrhosis is a risk for hepatocellular carcinoma (HCC) whatever the causeC. HCC are particularly sensitive to chemotherapyD. Liver ultrasound will detect the majority of liver tumoursE. Hemangiomas are the commonest benign liver tumours

27. The following statements is/are true;

A. serum amylase is rarely normal in acute pancreatitisB. ERCP may be useful in the diagnosis of acute pancreatitisC. Pseudocyst is an uncommon complication of acute pancreatitisD. Thromboplebitis migrans is associated with pancreatic cancerE. Ascites occurs early in the course of pancreatic cancer

28. The followings is/are true of infection involving the biliary tractA. bile within the biliary tree is usually sterileB. septicemic shock with gram negative organisms can occurC. a cholestatic picture may be seen biochemicallyD. blood cultures are rarely positiveE. ERCP is a risk factor for cholangitis

29. Acute pancreatitisA. Has overall mortality of 10 %B. May be related to bendrofluazideC. May be cause by seat belt traumaD. Commonly cause by e.coli infectionE. Plasma amylase is good indicator of severity of inflammation

30. Raised plasma amylaseA. Maybe asymptomaticB. May occur in rupture of ectopic pregnancyC. May occur in renal impairmentD. Greater than 5 times normal only be caused by acute pancreatitisE. In combination with gas in portal vein suggestive of intestinal ischemia

31. Carcinoma of pancreasA. 85% of tumor are unresectable at the time of diagnosisB. Overall 10 % 5 years survival.C. Related to OCP usage.D. CA-19-9 highly specific tumour marker E. May present with peripheral neuropathy

32. Acalculous cholecystitisA. Most commonly seen in middle age women with constipationB. Is thought to be splanchnic ischemiaC. Treated by percutaneous CholecystectomyD. Usually caused by clostridium infection E. Is realte dto gallbladdercarcinoma

33. Gallbladder stoneA. Mostly compose cholesterolB. Pigment stone caused by increase excretion of polymerized conjugated billirubinC. Are not a risk factor for the development of the gallbladder carcinomaD. Usually radiopaqueE. Impacted in the Hartman’s pouch cause mucocele of the gallbladder

34. Acute pancreatitis

A. Diagnosed by elevated serum LipaseB. Moderate severity when ranson score is 4C. Periampulary Carcinoma is a known cause of itD. ARDS is a known complicationE. Grey turner sign is indicative in haemorrhagic pancreatitis

35. Pancreatic carcinomaA. Obstructive jaundice with passage of dark urine is the commonest presentationB. Occur at head of gland more 85%C. A ductal carcinoma in 90% of casesD. Are solely detected by ultrasoundE. Most unsuitable for curative surgery

36. Non- surgical treatment of gallstoneA. Suitable for radioluscent stone less than 1cmB. Usually achieved by 3 month ursodeoxycholic acidC. May be undertaken by MTBED. Recommended by young patient awaiting for renal transplantE. Has low incident of recurrent stone after medical dissolution

37. CholangiocarcinomaA. Represent 1% of all GIT cancerB. Related to chlonorchis sinensis infectionC. Rarely associated with choledocholithiasisD. Metastases earlyE. Present with obstructive jaundice in 90 % of cases

38. Gallstone ileusA. Usually follows iatrogenic fistulation of the gallbladder in to the GIT tractB. Calculi usually impact in the proximal ileusC. Usually produces complete obstructionD. May produce in the biliary treeE. Is most common in the < 60 years old

39. Regarding fistulaA. is an extending from blind ending abscess cavityB. Healing is facilitated by recurrent infectionC. communication between 2 surfaces of epitheliumD. posterior type have multiple external openingE. High bowel fistula a/w severe electrolyte imbalance

40. Familial Adenomatous polyposisA. autosomal dominant.B. pre-malignantC. assoc with Crohn diseaseD. Cause electrolytes imbalanceE. majority treated with coloctomy

41. Constipation is a/w

A. OpiatesB. Ammonium Hydroxide preparationC. Hypothyroid D. Diabetes InsipidusE. Lactulose administration

42. Carcinoma of cecumA. Presented early with bloody diarrheaB. Presented by right hemicolectomyC. caused microcytis hypochromic anemiaD. diagnosed by sigmoidoscopyE. associated with chron’s disease

43. VolvolusA. causes venous infarctionB. cause peritonitisC. can be cured by barium enemaD. occur usually at sigmoid colonE. usually occurs in young adult

44. Colorectal carcinomaA. Low fibre diet is a predisposing factorB. Sunsburst appearance is a characteristic in barium enemaC. Patient presented with rectal bleeding and altered bowel habitD. Duke staging is a for prognosisE. Adenocarcinoma is a common histological type

45. Ureteric obstruction due to calculus , IVU showedA. Normal excretion on non affected kidneyB. Delayed exretion on affected kidneyC. Contraction on non –affected kidneyD. Normal ureteral diameterE. Site of obstruction

46. Folley’s catheterA. Must always do under aseptic techniqueB. is 24 mm lengthC. 24 mm diameterD. 24mm extrenal circumferenceE. is used for urethral cathetherisation in adult male

47. Renal Cell carcinomaA. can cause painful haematuriaB. metasteses to the boneC. metastases to IVCD. can cause cannon ball metastesesE. Is called Wilm’s tumour

48. Ca prostate

A. occur frequently in men > 65 years oldB. respond to testosterone therapyC. can invade rectal wall.D. produce osteosclerotic 2ndary bone depositE. spread to pelvic LN

49. Causes of acute testicular swellingA. epiddiimo-orchitisB. torsion of testisC. hydroceleD. seminomaE. Varicocele

50. Ureteric stoneA. Produce pain that colicky in natureB. should be surgically removedC. as predominantly ‘ triple phosphate”D. ESWL one of the treatment optionE. predispose to TCC ureter

51. Hypercalcemia can resultA. Renal stonesB. PolyuriaC. ConstipationD. Gall stoneE. Tetanus

52. Predisposing factor for renal calculiA. Liver cirrhosisB. Living or working in tropical climateC. ThyrotoxicosisD. Diabetes insipidusE. Malnutrition

53. Hematuria in abdominal injuryA. Exploration of the kidney immediatelyB. IVU is no valueC. CT scan abdomen should be performedD. Ureteric avulsion should be treated with by reconstruction an stentingE. concealed subcapsular hematoma can be treated conservatively

54. Renal transplantationA. Only done in patient less than 50 years oldB. Kidney will be put extraperitoneallyC. Urine output is monitored for rejectionD. Immunosuppressant medication is given E. Urinary tract infection is a relative contraindication

55. In acute pancreatitis

A. treatment with antibiotic is mandatoryB. DM is sequealeC. Is treated conservativelyD. Laparotomy is indicated in acute hemorhhagic necrotising typeE. A normal serum amylase can exlude acute pancreatitis

56. ERCPA. must be on general anesthesiaB. Containdicated in jaundiceC. Greater advantage than PTCD. used to confirm pancreatitisE. can be used to dx stricture of pancreatic duct

57. Ascending cholangitis a/w:A. FeverB. JaundiceC. GallstoneD. large intestine obstructionE. cholangiocarcinoma

58. Acute choleycytitisA. a/w gallstoneB. Antibiotic is based on C&S from lab IxC. Cholycystectomy ca be done later in convalescence stageD. Laparoscopic cholycystectomy is Treatment of choiceE. empyema is one of its complication

59. Regarding the imaging of gallbladderA. pt not need to be fastedB. Cholesterol stone is radio-opaqueC. chronic cholycytitis is esily distinguished from ca gallbladderD. chronic cholycystitisE. Ca head of pancrease cancer usually presented with over distended gallbladder

60. Regarding hydroceleA. is a pre-malignantB. may occur after operation of herniaC. occur in a tunica vaginalisD. Cause infertility in reproductive ageE. is reducible

61. Regarding hydrochepalusA. FTT is a featuresB. VP shuntC. classically divided into communicating and non-communicatingD. pre-malignantE. delayed repair cause the impaired

62. HPS

A. due to failue development of deudenal B. diagnosed clinicallyC. Ramsted operation is the treatmentD. Causes severe electrolyte imbalanceE. Genetic predisposing

63. IntusseptionA. In neonate usual require resection of bowelB. Can cause bowel obstruction C. causes red current jellyD. is a twisting of bowelE. Is treated with barium enema

64. Umbilical Hernia in 1 year old babyA. Resolved spontenoesly at age 2 yrsB. can cause MalignantC. due to incomplete form of umbilical ringD. can cause incarcerated bowel as a complicationE. treated by mayo repair

65. Obsturctive jaundice in neonatesA. Bliary atresia is a causeB. Can lead to liver damageC. Can be treated with kasaiD. liver transplant is an optionE. indirect billirubin is elevated

66. Inguinal herniasA. always directB. F> MC. present with irritability and vomitingD. incarcerated can be treated with TAXIS and sedationE. premature baby

67. Hircprung diseaseA. Common female than maleB. due to absence of ganglion aurbach’s plexusC. can be treted by Duhamel operationD. commonly occur at rectosigmoid junctionE. diagnosed ny barium male

68. Transportation of neonates from dictrict to referral hospitalA. Biochemical test are important as baseline IxB. fluid loss is a serious complication in gastrichisis and exomphalusC. transport in incubator can cuse hypothermiaD. In moving ambulance nothing much can be doneE. Baby with TOF must be mechanically ventilated