Surgery BCQ 2020

Topic: Fluid & Electrolytes management in Shock

Specialty: G.Surgery

Level: Undergraduate level

Theme: Dehydration

Sub theme: Management

Q:1 A 50 years male became dehydrated after episodes of persistent vomiting ,

later on as confirmed by lab tests, he developed hypokalemic metabolic alkalosis.
Which of the following I/V fluid replacement is most appropriate for this
condition?
a) Dextrose water 5%
b) Dextrose water 10%
c) Normal saline with KCl 0.9%
d) Plasma expander
e) Ringer’s lactate

Key: C
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27th edition p-

 Topic: Shock/Burn

Specialty: G.Surgery

Level: Undergraduate level

Theme: shock
Sub Theme: management/monitoring

Q:2 A 35 years young male has been received in emergency and accident
department in state of shock following significant burn injury some 4 hours ago.
While he has been resuscitated with I/v fluids, however you are concerned if this
is sufficient? You advise your resident to monitoring of vitals, state of hydration
and urine output.

What is the minimal adequate urine output for excretion of waste products?

a) 0.5 ml/kg/hr
b) 1ml/kg/hr
c) 1.5ml/kg/hr
d) 2ml/kg/hr
e) 3ml/kg/hr

Key: A
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27th edition p-

 Topic: Post- Operative fever

Specialty: G.Surgery

Level: Undergraduate level

Theme: post- operative fever
Sub Theme: causes

Q:3 A 60 years male developed fever after elective laparotomy within 48 hours.
What is the most common cause of fever during his early post-operative period?

a) Atelectasis
b) Deep Venous Thrombosis
c) Superficial thrombophlebitis
d) Urinary Tract Infection
e) Wound infection

Key: A
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27th edition p-

 Topic: Wound Infection

Specialty: G.Surgery

Level: Undergraduate level/Post graduate level

Theme: wound infection
Sub Theme: management

Q:4 A 45 years male was operated for colonic surgery. He developed fever and
wound infection after 5 days post operatively despite broad spectrum antibiotics.
Most appropriate next step for managing such type of wound infection would be?

a) Frequent change of wound dressing

b) Send blood culture
c) Send CBC and start antipyretics
d) Switch over to high dose of broad spectrum antibiotics
e) Wound should be opened

Key: E
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27th edition p-

 Topic: Wound Infection

Specialty: G.Surgery

Level: Undergraduate level

Theme: wound infection
Sub Theme: culprit micro-organisms

Q:5 A 60 years female underwent left Modified radical Mastectomy for Invasive
Ductal carcinoma. On her follow up after one week she presents with surgical site
infection. What are the most common organisms involved in wound infection?

a) Klebseila
b) Proteus
c) Pseudomonas
d) Staphylococci
e) Streptococci

Key: D
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27th edition p-

 Topic: Diagnostic Imaging

Specialty: G.Surgery

Level: Undergraduate level

Theme: Right hypochondrial pain
Sub Theme: Initial evaluation

Q:6 A 55 year obese lady presents to outpatient clinic with history of pain in right
hypochondrium ,belching and dyspepsia. Local Examination is un -remarkable.
You discuss the differential diagnosis in detail with the residents and inquire
about next step of evaluation to reach a diagnosis.

Most appropriate imaging tool used to reach some conclusion includes?

a) C.T scan abdomen

b) Endoscopic Retrograde Cholangio pancreatography (ERCP)
c) Magnetic Resonance Cholangio pancreatography (MRCP)
d) Plain X Ray abdomen
e) Ultrasound upper abdomen

Key: E
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27th edition p-

 Topic: G.Stones complications/ Intestinal Obstructyion

Specialty: G.Surgery

Level: Undergraduate level

Theme: small bowl obstruction
Sub Theme: Diagnosis/Etiology

Q:7 A 60 years lady is known case of Gall bladder disease. Now she presents with
symptoms of small bowel obstruction for last one day. Her plain X Ray abdomen
reveals multiple air-fluid levels and presence of air in the billiary tree
(pneumobilia) . What is the most likely diagnosis?

a) Acute cholecystitis infected with gas forming organisms.

b) Cholecysto-enteric fistula leading to gallstone ileus
c) Duodenal perforation
d) Gangrene of gallbladder
e) Rupture of gallbladder

Key: B
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27th edition p-

 Topic: Acute pancreatitis (Etiology)

Specialty: G.Surgery

Level: Undergraduate level

Theme: Severe Epigastric pain (pancreatitis)
Sub Theme: Etiology

Q:8 A 50 years obese, dehydrated female presents with severe epigastric pain
radiating to the back associated with vomiting. Clinical suspicious is high for
pancreatic which is later confirmed by raised serum amylase levels.

Regarding different causes of acute pancreatitis, the most common cause of acute
pancreatitis includes which of the following?

a) Alcohol
b) Drugs
c) CBD stone
d) Hyper lipidemia
e) Idiopathic

Key: C
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27th edition p-

 Topic: Esophageal disorders

Specialty: G.Surgery

Level: Undergraduate level

Theme: Gastroesophageal reflux

Sub Theme: Diagnosis

Q:9 A 35 years obese female is suffering from Gastro-esophageal reflux disease

for past 7 years. Her recent endoscopic evaluation with concomitant biopsy has
identified glandular metaplasia of the lower esophageal mucosa. What is the most
appropriate diagnosis of this condition?

a) Achalasia cardia
b) Barrett’s oesophagus
c) Leukoplakia
d) Plummer-vinson syndrome
e) Tylosis

Key: B
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27th edition p-

 Topic: Esophageal carcinomas

Specialty: G.Surgery

Level: Undergraduate level

Theme: dysphagia (ca esophagus)
Sub Theme: variants/types

Q:10 A 65 years male presented with progressive dysphagia and weight loss since
3 years. On oesophagoscopy and biopsy he is diagnosed as carcinoma involving
middle third of esophagus. What is the most common histo-pathological variety
of esophageal cancer?

a) Adenocarcinoma
b) Anaplastic carcinoma
c) Carcinoid tumour
d) Muco-epidermoid carcinoma
e) Squamous cell carcinoma

Key: E
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27th edition p-

 Topic: esophageal carcinomas

Specialty: G.Surgery

Level: Undergraduate level

Theme: Dysphagia ( CA esophagus)
Sub Theme: common site

Q:11 A 60 years male smoker has history of progressive dysphagia and weight
loss. Oesophagosycopy and biopsy has been performed to evaluate the cause
which shows oesophageal carcinoma. The most frequent site of involvement of
oesophageal cancer is:

a) Lower third of oesophagus

b) Middle third of oesophagus
c) Oesophagogastric junction
d) Pharyngo oesophageal junction
e) Upper third of oesophagus

Key: B
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27th edition p-

 Topic: Esophageal carcinomas

Specialty: G.Surgery

Level: Undergraduate level

Theme: ca esophagus
Sub Theme: clinical presentation

Q:12 In a surgical ward, while in an academic round, Professor is discussing

about various carcinomas related to Gastro intestinal tract. He inquires about
clinical presentation of carcinoma esophagus. Resident’s response is variable. He
further discuss to tell the single most common presentation .What is the most
common presenting symptom of oesophageal cancer?

a) Dysphagia
b) Hoarseness
c) Pain during swallowing
d) Regurgitation
e) Weight loss

Key: A
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27th edition p-

 Topic: CA Stomach

Specialty: G.Surgery

Level: Undergraduate level

Theme: shock
Sub Theme: management/monitoring

Q:13 In a surgical ward, while in an academic round, Professor is discussing about

various carcinomas related to Gastro intestinal tract. He inquires about various
histological types. Regarding carcinoma of stomach, what is the most common
histopathologic type?

a) Adenocarcinoma
b) Anaplastic carcinoma
c) Carcinoid tumour
d) Sarcoma
e) Squamous cell carcinoma

Key: A
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27th edition p-

 Topic: Intestinal Obstruction

Specialty: G.Surgery

Level: Undergraduate level

Theme: Colicky abdominal pain
Sub Theme: Diagnostic investigation

Q:14 A 40 years-male presents to emergency room with history of colicky upper

abdominal pain which is followed by distension and vomiting. You suspect
intestinal obstruction. What is the single best imaging tool of choice to establish
the diagnosis of small bowel obstruction?

a) Barium meal follow-through

b) C.T scan abdomen
c) MRI
d) Plain X-Ray abdomen Erect and supine
e) Ultrasound abdomen

Key: D
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27th edition p-

 Topic: Intestinal Obstruction

Specialty: G.Surgery

Level: Undergraduate level

Theme: abdominal distension
Sub Theme: etiology

Q:15 14 A 40 years-male presents to emergency room with history of abdominal

distension and absolute constipation. On examination, distension is more marked
in lower abdomen. X-ray abdomen shows dilated bowel loops more on periphery.
You suspect large bowel obstruction.

The most common cause of large bowel obstruction is ?

a) Carcinoma
b) Diverticular disease
c) Hernia
d) Intussusception
e) Volvulus

Key: A
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27th edition p-

 Topic: Hernias

Specialty: G.Surgery

Level: Undergraduate level

Theme: Inguinal Hernia
Sub Theme: Surgical anatomy

Q:16 You are operating upon a patient of Inguinal hernia. Your resident is very
excited as he claims that he has studied surgical anatomy a night before scrubbing
on the case. To test his understanding you ask a question related to surgical
anatomy of groin. What is the other name of cooper’s ligament?

a) Gimbernat ligament
b) Ileopectineal ligament
c) Inguinal ligament
d) Lacunar ligament
e) Poupart ligament

Key: B
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3
 Reference: Bailey & Love,27th edition p-
Topic: Pancreatitis

Specialty: G.Surgery

Level: Undergraduate level

Theme: severe abdominal pain
Sub Theme: clinical signs
Q:17 a 40 –years alcoholic male presents to emergency room with severe
upper abdominal pain and vomiting for one day. On examination he looks ill
and dehydrated. Abdominal examination shows a visible bluish
discoloration in the left you suspect hemorrhagic pancreatitis. Most likely
this sign is called as?

a) Cullen’s sign
b) Grey turner’s sign
c) Kehar’s sign
d) Pemberten’s sign
e) Rovsing’s sign

Key: B
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27th edition p-

 Topic: colorectal carcinoma

Specialty: G.Surgery

Level: Undergraduate level

Theme : colorectal carcinoma
Sub Theme: site

Q:18 A 60 years old male presents with complain of weight loss ,loss of apettite
and constipation.On examination he looks pale, wasted. On Abdominal
examination vague mass palpable, in which part of the large bowel do most
colorectal cancer occur?

a) Caecum
b) Ascending colon
c) Transverse colon
d) Descending colon
e) Sigmoid colon and rectum

Key: E
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27th edition p-

 Topic: colorectal carcinoma

Specialty: G.Surgery

Level: Undergraduate level

Theme: colorectal carcinoma
Sub Theme: etiology

Q19.During a bedside round by a professor on an old aged male with suspected

colorectal carcinoma ,professor inquiries from his residents about statics of
cancer risk. What is the lifetime risk of colorectal cancer?

a) 1%
b) 5%
c) 10%
d) 15%
e) 20%

Key: B
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27th edition p-

 Topic: colorectal carcinoma

Specialty: G.Surgery

Level: Undergraduate level

Theme: colorectal carcinoma
Sub Theme: etiology

Q: 20.During a bedside round by a professor on an old aged male with suspected

colorectal carcinoma, professor inquiries from his residents about statics of
cancer risk. Risk factors associated with colorectal cancer include which one of
the following?

a) Chronic constipation
b) Chronic aspirin therapy
c) Irritable bowel syndrome
d) Low intake of dietary fiber
e) Low intake of red meat

Key: D
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27th edition p-

 Topic: colorectal carcinoma

Specialty: G.Surgery

Level: Undergraduate level

Theme: colorectal carcinoma
Sub Theme: diagnosis

Q :21 In a periphery area where the expertise are deficient, depending upon
presenting symptoms one may suspect the left colonic carcinoma in high risk
patients .Characteristic presenting feature of left sided colonic tumors is:

a) A change in bowel habit

b) Fresh bleeding pre rectum
c) Foul smelling stools which are difficult to flush
d) Iron deficiency anemia
e) Painless abdominal mass

Key: A
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27th edition p-

 Topic: colorectal carcinoma

Specialty: G.Surgery

Level: Undergraduate level

Theme: colorectal carcinoma
Sub Theme: prognosis

Q: 22 A son of old aged father is newly diagnosed case of colorectal carcinoma,

his son is worried about his father and outcome of his disease. His disease has
poor prognosis. Which of the following feature is associated with poor prognosis
in colorectal cancer?

a) Adenocarcinoma cell type

b) Rectal bleeding at presentation
c) Lymphocytic response to tumor
d) Presence of involved lymph nodes
e) Painless abdominal mass

Key: D
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27th edition p-

 Topic: colorectal carcinoma

Specialty: general surgery

Level: Undergraduate level

Theme: colorectal carcinoma
Sub Theme: management

Q:23. 22 A son of old aged father is newly diagnosed case of colorectal

carcinoma, his son is worried about his father and outcome of his disease. His
disease is metastasis. Regarding metastasis from colorectal cancer and its
management.

A) Chemotherapy has no effect on survival

B) Cerebral metastases are common
C) Hyper-proteinemia is common
D) Liver metastases are a rare feature
E) Liver capsule pain usually responds well to non-steroidal anti-
inflammatory drugs

Key: E
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: THYROID

Specialty: general surgery

Level: Undergraduate level

Theme: GRAVES DISEASE
Sub Theme: Diagnosis

Q: 24 A young lady comes to OPD with nervousness, fatigue, palpitation, heat

intolerance and weight loss. On clinical grounds hyperthyroidism is suspected.
The most common condition causing hyperthyroidism is?

a) Grave’s disease
b) Iatrogenic hyperthyroidism
c) Pituitary thyrotropin secreting tumor
d) Plummer’s disease
e) Thyroiditis
Key: E
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Fluid & Electrolytes management in Shock

Specialty: G.Surgery

Level: Undergraduate level

Theme: Hyperthyrodism

Sub theme: Treatment options

Q:25 A 30 years old lady attends to outpatient department with diffuse swelling
in front of neck associated with palpitation, heat intolerance and some weight
loss. She recently had Thyroid functions test and thyroid scan which confirm it
diffuse toxic goiter. The treatment options for this condition are antithyroid drugs,
radio iodine, and surgery. What is the absolute contraindication of radio iodine
therapy?

a) Bronchial asthma
b) Cardiac failure
c) Morbid obesity
d) Pregnancy
e) Renal failure

Key: D
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Thyroid Cancers

Specialty: G.Surgery

Level: Undergraduate level

Theme: Neck swelling with Hoarseness

Sub theme: Management

Q:26 A 55 years old lady with long standing history of thyroid swelling presents to
opd with recent history of discomfort, weight loss and hoarseness of voice.
Clinical examination reveals hard fixed thyroid swelling .FNAC shows malignant
cells. Which of the following is the most common variety of thyroid cancer?

a) Anaplastic carcinoma
b) Follicular carcinoma
c) Lymphoma
d) Medullary carcinoma
e) Papillary carcinoma

Key: E

Difficulty level: Hard/Moderate/Easy

Importance: Essential /Moderate/ Supplementary

C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Thyroid Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Malignant Thyroid swelling

Sub theme: Diagnosis

Q:27 A 25 year old man presents to surgical OPD with a 4 cm mobile anterior
neck mass. FNAC reveals cells with ‘orphan Annie eye’ nuclei and psamomma
bodies. What is the most likely diagnosis?

A) Benign thyroid nodule

B) Follicular carcinoma
C) Medullary carcinoma
D) Papillary carcinoma
E) Thyroglossal cyst

Key: D
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Thyroid Carcinomas

Specialty: G.Surgery

Level: Undergraduate level

Theme: Medullary carcinoma thyroid

Sub theme: Characteristic features

Q:28 A 45 year old female presents to surgical OPD with a 4 cm mobile anterior
neck mass. FNAC reveals atypical cells in colloid background consistent with
medullary carcinoma of thyroid.

Which of the following features is consistent with a medullary carcinoma?

A) Diagnosis of MEN-I syndrome

B) Grossly soft and tender mass
C) Haematologic metastatic spread
D) Increased serum calcitonin levels
E) Localized amyloid deposits

Key: D
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Thyroid Carcinomas

Specialty: G.Surgery

Level: Undergraduate level

Theme: Neck swelling with low calcium levels

Sub theme: Diagnosis

Q:29 A 46 year old female presents to OPD with a 3cm anterolateral firm painless
neck mass along with a minor decrease in serum calcium level. FNAC is suggestive
of malignanacy. What is the most likely diagnosis?

a) Anaplastic carcinoma
b) Follicular carcinoma
c) Medullary carcinoma
d) Papillary carcinoma
e) Parathyroid carcinoma

Key: C
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Thyroid carcinomas

Specialty: G.Surgery

Level: Undergraduate level

Theme: Thyroid carcinoma

Sub theme: Prognosis

Q:30 A 45 year old female presents to surgical OPD with a 4 cm mobile anterior
neck mass. FNAC reveals atypical cells suggestive of Thyroid malignancy.
Regarding different types of thyroid carcinoma which type is associated with the
worst prognosis?

(Choose the answer that shows the correct descending order, the first being the
cancer with the worst prognosis and the last being the one with the best
prognosis)

a) Anaplastic>Medullary>Follicular>Papillary
b) Anaplastic>medullary>Papillary>Follicular
c) Anaplastic>Papillary>medullary>Follicular
d) medullary> Anaplastic> Papillary> Follicular
e) medullary> Anaplastic> Follicular>Papillary

Key: A
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Thyroid

Specialty: G.Surgery

Level: Undergraduate level

Theme: Neck swelling

Sub theme: Diagnosis

Q:31 A 18 year old female presents with a painless swelling of 1.5*1cm in the
anterior neck region which moves on deglutition. A biopsy is taken revealing fluid
contained within pseudo-stratified columnar epithelium. What is the most likely
diagnosis?

a) Bronchial cyst
b) Follicular adenoma
c) Parotid tumour
d) Thyroglossal cyst
e) Thyroid cystitis

Key: D
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Tumor markers

Topic: Hepatocellular carcinoma

Specialty: G.Surgery

Level: Undergraduate level

Theme: Hepatocellular carcinoma

Sub theme: Tumour Markers

Q:32 During a lecture of pathology, Teacher discusses about tumour markers as

blood chemicals produced by the different malignant cells and every tumour has
its own characteristic marker associated with it.

Which of the following is the tumour marker associated with hepatocellular

carcinoma?

a) AFP
b) Beta-HCG
c) CA 19-9
d) CA-125
e) CEA

Key: A

Difficulty level: Hard/Moderate/Easy

Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3
Reference: Bailey & Love,27h edition payment
 Topic: Carcinoma Colon

Specialty: G.Surgery

Level: Undergraduate level

Theme: Colonic Cancer

Sub theme: Tumour Marker

Q:33 During a lecture of pathology, Teacher discusses about tumour markers as

blood chemicals produced by the different malignant cells and every tumour has
its own characteristic marker associated with it.

Which of the following tumour marker is associated with colonic cancer?

a) AFP
b) CA 15-3
c) CA 19-9
d) CA 27-29
e) CEA

Key: E
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:34 During a lecture of pathology, Teacher discusses about tumour markers as

blood chemicals produced by the different malignant cells and every tumour has
its own characteristic marker associated with it.

Which of the following tumour marker is associated with carcinoma breast?

a) Beta-HCG
b) BRCA1 and BRCA2
c) BTA
d) CA 19-9
e) CEA

Key: B
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Testicular Tumours

Specialty: G.Surgery

Level: Undergraduate level

Theme: Testicular Teratoma

Sub theme: Tumour markers

Q:35 During a lecture of pathology, Teacher discusses about tumour markers as

blood chemicals produced by the different malignant cells and every tumour has
its own characteristic marker associated with it.

Which of the following tumour marker is specific for testicular teratoma?

a) AFP
b) BTA
c) CA 27-29
d) CEA
e) PSA

Key: A
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Thyroid carcinomas

Specialty: G.Surgery

Level: Undergraduate level

Theme: Medullary Thyroid Carcinoma

Sub theme: Tumour Marker

Q:36 During a lecture of pathology, Teacher discusses about tumour markers as

blood chemicals produced by the different malignant cells and every tumour has
its own characteristic marker associated with it.

Which of the following tumour marker is specific for medullary carcinoma of

thyroid

a) Calcitonin
b) CA-125
c) CA 15-3
d) CA 19-9
e) Thyroglobulin

Key: A
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Prostate carcinomas

Specialty: G.Surgery

Level: Undergraduate level

Theme: carcinoma prostate

Sub theme: Tumour Marker

Q:37 During a lecture of pathology, Teacher discusses about tumour markers as

blood chemicals produced by the different malignant cells and every tumour has
its own characteristic marker associated with it.

Which of the following tumour marker is associated with carcinoma prostate?

a) AFP
b) Beta-hCG
c) BTA
d) LDH
e) PSA

Key: E
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level/post graduate

Theme: Malignant breast lump

Sub theme: Management

Q:38 A 38 years female is diagnosed with right breast cancer. Clinical

examination and imaging identifies a lump of 3*3 cm in upper outer quadrant
with benign axillary nodes. Patient is interested in conserving breast. You advise
for Neo adjuvant chemotherapy.

Regarding management of malignant tumor, neo-adjuvant therapy is described

as:

a) The process of periodic testing individuals for detecting a potential

malignancy in someone.
b) A kind of therapy to ablate the disease completely.
c) In incurable disease, measures can still be taken to ease the symptoms of
the patient.
d) Chemotherapy before planning for surgical resection of tumour
e) Radiochemotherapy after surgical resection of tumour.

Key: D
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Acute abdomen

Specialty: G.Surgery

Level: Undergraduate level

Theme: Abdominal pain

Sub theme: Characteristics

Q:39 While discussing different characteristics of pain in a class of third year

students, one of student ask about colicky pain. You explain that colicky pain is
the result of smooth muscle contraction against a resistance.

Which of the following pathological condition causing colicky abdominal pain?

a) Acute appendicitis
b) Acute cholecystitis
c) Acute hepatitis
d) Acute intestinal obstruction
e) Acute pancreatitis
Key: D
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Hepatobiliary Tract

Specialty: G.Surgery

Level: Undergraduate level

Theme: Obstructive jaundice

Sub theme: Differentials

Q: 40 In a round, resident presents a case of 55 years old male with obstructive

jaundice. When you inquires about the possible causes, his knee jerk response is
choledocolithiasis. On examination, Gladder is palpable. You ask resident about
Courvoisier’s law.

Regarding Courvoisier’s law.

a) If infection of the common bile duct supervenes , the jaundice and pain are
complicated by high grade fever
b) If in the presence of jaundice gallbladder is palpable then the jaundice is
unlikely to be due to stone
c) If the nontender gallbladder is palpable without the presence of jaundice
d) If the tender gallbladder is palpable associated with high grade fever and
severe toxaemia, but no jaundice
e) Stone is impacted in Hartmann’s pouch causing jaundice due to
compression of the common bile duct

Key: B
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Spleen

Specialty: G.Surgery

Level: Undergraduate level

Theme: Splenomegaly

Sub theme: Indications of splenectomy

Q:41 During a lecture of surgery, different causes of splenomegaly are being

discussed.

Regarding splenomegaly which of the following conditions need splenectomy?

a) Chronic myeloid leukemia

b) Idiopathic thyrombocytopenic purpura
c) Lymphoma
d) Myelofibrosis
e) Polycythaemia

Key: B
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Spleen

Specialty: G.Surgery

Level: Undergraduate level

Theme: Splenectomy

Sub theme: Complications

Q:42 During a lecture of surgery , different post-operative complications after

splenectomy are being discussed. Splenectomy predisposes the patient,
especially a child to infection

Which of the following organisms are involved in such infectious complications?

a) E.coli
b) Klebseila
c) Pseudomonas
d) Pneumococci
e) Staphylococci

Key: D
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Stomach

Specialty: G.Surgery

Level: Undergraduate level

Theme: Abdominal mass with supraclavicular node

Sub theme: Causes

Q:43 A middle aged female presents with history of weight loss, abdominal mass
and enlargement of left supraclavicular node. You teach accompanying interns
and residents about Virchow’s node that it is a prominent lymph node in the left
supraclavicular fossa in response to malignant disease spread from some primary
lesions.

Which of the following primary lesion have association with Virchow’s node?

a) Adrenal tumour
b) Colo-rectal carcinoma
c) Gastric carcinoma
d) Renal cell carcinoma
e) Uterine carcinoma

Key: C
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Lymphedema

Specialty: G.Surgery

Level: Undergraduate level

Theme: Lymphedema

Sub theme: causes

Q:44 A 42 years male presents in OPD with enormous swelling of right leg. A
gross lymphedema of the lower limbs is often called elephantiasis, is consequent
lymphatic obstruction caused by parasitic infection of the lymphatics

.Which of the following parasites are responsible for this condition?

a) Filaria
b) Giardia
c) Leishmania
d) Trichomonas
e) Trypnosomas

Key: A
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Breast

Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer with eczematous lesion

Sub theme: Diagnosis

Q:45 An elderly woman presents with a unilateral red, eczematous lesion of the
nipple, associated with underlying carcinoma of the breast.

The most likely this condition is called as:

a) Actinomycosis
b) Bacterial mastitis
c) Duct ectasia
d) Mondor’s disease
e) Paget’s disease of the nipple

Key: E
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:46 When there is thrombophlebitis of the superficial veins of the breast and
anterior chest wall occur in a woman, this condition is usually labeled as:

A) Duct ectasia
B) Mastitis
C) Mondor’s disease
D) Pagets’s disease
E) Tuberculosis

Key: C
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:47 In any patient who presents with a breast lump or other symptoms
suspicious of carcinoma, diagnosis should be made by triple assessment. It is a
combination of:

A) Clinical assessment, U/S breast & mammography

B) Clinical assessment, U/S breast & CT scan chest
C) Clinical assessment, U/S breast & tissue sampling taken for either
cytological or histological analysis
D) U/S breast, CT scan chest & FNAC
E) U/S breast, MRI & Trucut needle biopsy

Key: C
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:48 Which of the following breast carcinoma is commonly multifocal and/or

bilateral, hence the increasing use of MRI for assessment?

A) Ductal carcinoma
B) Inflammatory carcinoma
C) Invasive lobular carcinoma
D) Mucinous carcinoma
E) Tubular carcinoma

Key: C
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:49 Although any portion of the breast may be involved with breast tumour,
which of the following sites is the most frequent for development of breast
cancer?

A) Lower outer quadrant

B) Lower inner quadrant
C) Nipple and areola
D) Upper outer quadrant
E) Upper inner quadrant

Key: D
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition p-

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:50 There are certain etiological factors for the development of carcinoma
breast. Which of the following factors is considered to be protective in the
occurrence of Ca breast?

A) Alcohol intake
B) First child at an early age
C) Obesity
D) Oral contraceptive pills
E) Previous radiation

Key: B
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:51 Which of the following agents is used as an adjuvant therapy in breast

cancer, that contain monoclonal antibodies against tumour growth factor
receptors HER-2/neu?

A) Anastrazole (femara)
B) Cyclophosphamide
C) 5-Fluorouracil
D) Tamoxifen
E) Transt
F)
G) uzumab (Herceptin)

Key: E
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:52 Which of the following drugs is the most widely used hormonal treatment in
breast cancer as an adjuvant therapy?

A) Anastrazole
B) Danazole
C) LHRH agonist
D) Transtuzumab (Herceptin)
E) Tamoxifen

Key: E
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:53 The incidence of carcinoma of the male breast accounts for:

A) <0.5%
B) 2%
C) 5%
D) 10%
E) 20%

Key: A
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:54 A population screening programme that could detect tumours before they
come to the patient’s notice might reduce mortality from breast cancer. Which is
the best method of screening for breast cancer in women over the age of 50 years
in three years interval?

A) CT scan breasts
B) Mammography
C) MRI breasts
D) Thermography
E) Ultrasound breasts

Key: B
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:55 The BRCA 1 gene has been associated with an increased incidence of breast
cancer. Which of the following malignancies is also associated with the same
gene?

A) Bronchogenic carcinoma
B) Gastric cancer
C) Ovarian cancer
D) Pancreatic cancer
E) Uterine cancer

Key: C
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:56 Recent development in molecular genetics and the identification of a

number of breast cancer predisposition genes have been described. Which of the
following genes is associated with familial male breast cancer?

A) BRCA 1
B) BRCA 2
C) HER-2
D) P 53
E) P 450

Key: B
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition

 NECK

Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:57 The lymphnodes in the neck have historically been divided into six anatomic
lymphnode levels for the purpose of head and neck cancer staging & therapy
planning. The submental and submandibular group of lymphnodes are included
in:

A) Level I
B) Level II
C) Level III
D) Level IV
E) Level V

Key: A
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:58 The posterior cervical triangle group of lymphnodes are included in:

A) Level I
B) Level II
C) Level III
D) Level IV
E) Level V

Key: E
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:59 The pretracheal & paratracheal group of lymphnodes are included in:

A) Level II
B) Level III
C) Level IV
D) Level V
E) Level VI

Key: E
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:60 A 20 years young female presented with euthyroid goiter since childhood
associated with severe sensorineural hearing impairment. Her two sisters have
the same problem. What is the most appropriate diagnosis?

A) Autoimmune thyroiditis
B) Endemic goiter
C) Hashimoto’s disease
D) Pendred syndrome
E) Secondary to pituitary or hypothalamic disease

Key: D
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:61 The most important factor in the development of endemic goiter is:

a) Dyshormonogenesis
b) Goitrogens
c) Iatrogenic
d) Iodine deficiency
e) Secondary to pituitary or hypothalamic disease

Key: D
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:62 The most important factor in the development of sporadic goiter probably is
defective hormone synthesis. Which of the following is the most probably cause
of this type of goiter?

a) Dyshormonogenesis
b) Hashimoto’s thyroiditis
c) Goitrogens
d) Iatrogenic (drug induced)
e) Iodine deficiency

Key: A
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:63 Radio isotope thyroid scanning is the mainstay of investigation indicated in

which of the following thyroid abnormalities?

a) Colloid goiter
b) Diffuse toxic goiter
c) Puberty goiter
d) Simple diffuse goiter
e) Toxic nodular goiter

Key: E
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:64 Which of the following is the investigation of choice in solitary thyroid

swelling?

a) C.T scan of neck

b) FNAC
c) Thyroid scan
d) Thyroid profile
e) U/S neck

Key: B
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:65 Most of the thyroid conditions may be diagnosed by FNAC. Which of the
following conditions that cannot be diagnosed by FNAC:

a) Anaplastic carcinoma
b) Follicular carcinoma
c) Medullary carcinoma
d) Papillary carcinoma
e) Thyroiditis

Key: B
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:66 During clinical examination of goiter, Pemberton’s sign is usually positive in:

a) Colloid goiter
b) Diffuse toxic goiter
c) Malignant goiter
d) Retrosternal goiter
e) Toxic multinodular goiter

Key: D
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:67 Which of the following thyroid abnormality is usually called as Grave’s

disease?

a) Colloid goiter
b) Diffuse toxic goiter
c) Hashimoto’s throiditis
d) Toxic nodular goiter
e) Toxic adenoma

Key: B
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:68 Which of the following thyroid abnormality is usually termed as Plummer’s

disease (secondary thyrotoxicosis)?

a) Autoimmune thyroiditis
b) Diffuse toxic goiter
c) Toxic multinodular goiter
d) Toxic adenoma
e) Thyrotoxicosis factitia

Key: C
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:69 A 55 years female underwent subtotal thyroidectomy for toxic goiter. After 5
years she developed recurrent thyrotoxicosis. What is the treatment of choice in
this condition?

a) Antithyroid drugs
b) Immunotherapy
c) Observation
d) Radio iodine therapy
e) Surgery with completion thyroidectomy

Key: D
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition

 Topic: Breast Cancer

Specialty: G.Surgery

Level: Undergraduate level

Theme: Breast Cancer

Sub theme: Tumour Marker

Q:70 Which of the following thyroid operations is also called Dunhill procedure?

a) Isthmusectomy
b) Lobectomy + isthmusectomy
c) Near total thyroidectomy
d) Sub-total thyroidectomy
e) Total thyroidectomy

Key: C
Difficulty level: Hard/Moderate/Easy
Importance: Essential /Moderate/ Supplementary
C1/ C2 / C3

Reference: Bailey & Love,27h edition

Q:71 Which of the following investigations have the key role for the diagnosis of
thyroid carcinoma?

a) CT scan neck
b) FNAC
c) Incisional biopsy
d) MRI
e) Ultrasound thyroid

Q:72 Among the various types of thyroid cancer, which of the following tumors
have properties of local infiltration as an early feature?

a) Anaplastic carcinoma
b) Follicular carcinoma
c) Lymphoma
d) Medullary carcinoma
e) Papillary carcinoma

Q:73 CEA is a tumor marker considered specific in colorectal cancer. In which of

the following thyroid malignancies CEA may also be raised?

a) Anaplastic carcinoma
b) Follicular carcinoma
c) Lymphoma
d) Medullary carcinoma
e) Papillary carcinoma
Q:74 Which of the following thyroid conditions are now being detected by genetic
screening, when found positive will develop thyroid cancer, therefore
recommended for prophylactic total thyroidectomy?

a) Anaplastic carcinoma
b) Follicular carcinoma
c) Lymphoma
d) Medullary carcinoma
e) Papillary carcinoma

Parathyroid gland
Q:75 Which is the best non invasive modality of investigation for localization of
parathyroid adenoma?

a) CT scan neck
b) High frequency neck ultrasound
c) MIBI isotope scan
d) MRI
e) PET scan

Q:76 Primary hyperparathyroidism is commonly a sporadic disorder associated

with hypercalcaemia and inappropriately raised serum PTH. Which of the
following is the most probable cause of this condition?

a) Chronic renal failure

b) Malabsorption
c) Vitamin D deficient rickets
 d) Parathyroid adenoma
e) Pseudohypoparathyroidism

Adrenal gland
Q:77 Pheochromocytoma is a tumor of the adrenal medulla which produce
catecholamines. What is the incidence of malignancy in these tumors?

a) 5%
b) 10%
c) 20%
d) 30%
e) 40%

Q: 78 A 40 years male presented with pyroxysmal attacks of headache, palpitation

and sweating. His BP is raised and suspected having pheochromocytoma. What is
the 1st step in the diagnosis of this condition?

a) CT scan abdomen
b) MIBG scan
c) MRI
d) PET scan
e) 24 hours urinary metanephrine and normetanephrine

Q:79 After biochemical diagnosis of pheochromocytoma with high levels of

metanephrine and normetanephrine in 24 hours urine, what is the next
investigation of choice for the localization of this lesion?

a) U/S abdomen
b) CT scan
c) MIBG scan
d) MRI
e) PET scan
 Lungs
Q:80 Lung cancer is one of the most common cancers throughout the world and is
the most common cause of cancer death. The occurrence of most common type
of lung cancer is:

a) Adenocarcinoma
b) Bronchioalveolar carcinoma
c) Large cell undifferentiated carcinoma
d) Small cell lung cancer
e) Squamous cell carcinoma

Q:81 Among the various types of lung cancers, which of the following histological
type tends to metastasize early, and usually associated with the development of
myopathies?

a) Adenocarcinoma
b) Bronchoalveolar carcinoma
c) Large cell carcinoma
d) Small cell carcinoma
e) Squamous cell carcinoma

Q:82 Which of the following is the most common primary mediastinal tumor,
accounting for 25% of the total tumors?

a) Germ cell tumor

b) Lymphoma
c) Lipoma
d) Neurofibroma
e) Thymoma

Vascular
Q:83 Chronic arterial stenosis or occlusion is commonly caused by atheroma.
Which of the following is the early feature of chronic arterial occlusion in the leg?

a) Absent arterial pulsations

b) Gangrene of toes
c) Intermittent claudication
d) Rest pain
e) Ulceration

Q:84 Acute arterial occlusion is usually caused by:

a) Arthrosclerosis
b) Air embolism
c) Fat embolism
d) FB embolism
e) Thrombo embolism

Q:85 The compartment syndrome of lower limb occurs after an injury or burn,
resulting blood or inflammatory fluid accumulated in the compartment causing
pain, pallor, paresthesia. What is the best urgent treatment for this condition?

a) Amputation
b) Elevation of leg
c) Fasciotomy
d) Hyperbaric oxygen
e) Observation, antibiotics and analgesics

Q:86 Which of the following is the mainstay of investigation for the management
of varicose veins?

a) Descending intravenous venography

b) Duplex ultrasound imaging
 c) Magnetic resonance venography
d) Tourniquet test
e) Vericography

Q:87 The best method of investigation for the diagnosis of DVT is:

a) Ascending venography
b) Clinical examination by performing Homan’s sign
c) D-Dimer test
d) Duplex ultrasound imaging
e) MRI

Q:88 Which of the following is the more effective method of prophylaxis against
development of deep venous thrombosis in moderate to high risk patients?

a) External pneumatic compression

b) Graduated elastic compression
c) Low molecular weight heparin
d) Unfractionated heparin
e) Warfarin

Q:89 Patients who are confirmed to have a DVT on duplex imaging should be
treated immediately with:

a) Low molecular weight heparin with warfarin

b) Arteriovenous fistula formation to increase venous flow
c) Surgical venous thrombectomy
d) Thrombolysis
e) Tissue plasminogen activator is administered

Q:90 Among all the ulcers in lower leg, which of the following is the most
common etiological type of this non-healing ulcer?

a) Arterial ischaemic ulcer

b) Neuropathic ulcer
 c) Neoplastic ulcer
d) Traumatic ulcer
e) Venous disease ulcer

Q:91 Lymphoedema are classified into primary and secondary. Among the
secondary lymphoedema , what is the most common cause of world wide,
particularly prevalent in Africa and india?

a) Filariasis
b) Lymphoma
c) Lymphnode
d) Radiotherapy to lymphnode
e) Surgical excision of lymphnodes

Q:92 Which of the following parasite is responsible for filariasis and spread by the
mosquito?

a) Dracunculus medinensis
b) Trypanosoma brucei
c) Toxoplasma gondii
d) Schistosoma mansoni
e) Wuchereria bancrofti

Q:93 Which of the following method of investigation is useful as the primary

diagnostic technique for lymphoedema in cases of clinical uncertainty ?

a) CT scan midcalf and pelvis

b) Doppler ultrasound
c) Isotope lymphoscintigraphy
d) Lymphangiography
e) MRI

Hernia
Q:94 An interstitial hernia occurs when the hernia extends between the layer of
muscle and not directly through them. The typical example is:

a) Incarcerated hernia
b) Pantaloon hernia
c) Richter’s hernia
d) Sliding hernia
e) Spigelian hernia

Q:95 For most of the hernias, which of the following method of investigation is
required?

A) Clinical examination
B) Barium contrast study
C) CT scan
D) Laparoscopy
E) Ultrasound

Q:96 Which of the following type of meshes is used more frequently for inguinal
hernia repair both with open or laparoscopic technique?

A) Biological mesh
B) Polyglycolic acid mesh
C) Polyester mesh
D) Polypropylene mesh
E) Polytetra fluoroethylene mesh

Q:97 In laparoscopic ventral hernia surgery, which of the following position of the
mesh is usually applied?

A) Onlay
B) Sublay
 C) Inlay
D) Preperitoneal
E) Intraperitoneal

Q:98 The testis descends from the abdominal cavity to the scrotum in the male by
passing through deep inguinal ring. The deep inguinal ring is a defect in the:

A) External oblique apponeurosis

B) Internal oblique apponeurosis
C) Transversus abdominis apponeurosis
D) Fascia Transversalis
E) Peritoneum

Q:99 During decent of testis, it passes through deep ring, travel in to inguinal
canal, emerges through superficial inguinal ring, descends into the scrotum. The
superficial inguinal ring is a v-shaped defect in the?

a) External oblique apponeurosis

b) Internal oblique apponeurosis
c) Transverses abdominis
d) Fascia transversalis
e) Rectus abdonimis fascia

Q:100 Which of the following open surgical procedure is most commonly

performed as tension free repair for inguinal hernia?

a) Bassini repair
b) Desarda repair
c) Darn’s repair
d) Lichtenstein repair
e) Shouldice repair

Hernia
Q:1 The incidence of congenital umbilical hernia occurs upto 10% of infants.
Which of the following treatment options is indicated in asymptomatic hernia
under the age of two years?

a) Conservative treatment and reassurance to parents

b) Laparoscopic hernia repair
c) Open surgery through sub umbilical incision and defect is closed with
interrupted suture.
d) Open surgery with umbilical excision and defect is closed with interrupted
suture
e) Open surgery with mesh repair

Q:2 Which of the following types of meshes is commonly used for laparoscopic
intraperitoneal ventral hernia repair?

a) Absorbable polyglycolic acid fibre mesh

b) Biological mesh
c) Composite mesh with sticky and slippery surfaces
d) Polypropylene mesh
e) Polytetrafloroethylene mesh

Q:3 Epigastric hernia arises through a defect in the linea alba anywhere between
the xyphoid process and the umbilicus. It commonly contains:

a) Extraperitoneal fat
b) Falciform ligament
c) Intestinal loop
d) Omentum
e) Part of greater curvature of the stomach

Q:4 Which of the following ventral hernias is prone to be obstructed and

strangulated?

a) Epigastric hernia
b) Incisional hernia
 c) Parastomal hernia
d) Paraumbilical hernia in adults
e) Umbilical hernia in children

Peritoneum
Q:5 Peritonitis is simply defined as inflammation of peritoneum. Acute bacterial
peritonitis is most commonly caused by:

a) Gastro intestinal perforation

b) Female genital tract infection
c) Ischaemic bowel disease
d) Primary peritonitis
e) Pancreatitis

Q:6 Primary spontaneous peritonitis is a rare form of acute bacterial peritonitis,

occurs through:

a) Female genital tract

b) Gastro intestinal perforation
c) Haematogenous spread
d) Penetrating abdominal trauma
e) Transmural bacterial translocation

Q:7 Primary bacterial peritonitis is usually caused by which organism?

a) Bacteriodes fragilis
b) E-coli
 c) Klebsiela
d) Pseudomonas
e) Pneumococci

Q:8 Acute bacterial peritonitis is commonly caused by gastrointestinal perforation

leading to septicaemia. Which of the following gut organism produce harmful
exotoxins?

a) Bacteroides fragilis
b) Clostridium welchii
c) E-coli
d) Klebsiela
e) Streptococci

Q:9 Tuberculosis can spread to peritoneum through GI tract via mesenteric

lymphnodes, or directly from the blood, usually from the milliary tuberculosis.
The accurate method of diagnosis of peritoneal tuberculosis is:

a) Ascitic fluid DR
b) Ascitic fluid for acid-fast bacilli stain
c) CT scan abdomen
d) Diagnostic laparoscopy and peritoneal biopsy
e) Ultrasound abdomen

Q:10 The pelvic cavity is the most common site of abscess formation in post
operative intra abdominal sepsis. The best treatment option is:

a) CT guided supra pubic drainage.

b) Laparotomy
c) Laparoscopy
 d) Rectal drainage
e) Ultrasound guided supra pubic drainage

Q:11 Ascitic aspiration is most commonly performed under imaging guidance and
sent to lab for DR. When report suggests a straw colored exudate containing
protein>30gm/L, WBC>500mm3 and lymphocytes>40%. What could be the
underlying cause of this ascitis?

a) Cirrhosis
b) Congestive cardiac failure
c) Malnutrition
d) Nephrotic syndrome
e) Tuberculous peritonitis

Q:12 A 45 years male was having ascitis on clinical examination. His ascitic fluid
sample was sent to lab after diagnostic aspiration, report suggests transudatic
fluid with protein< 25g/l. What could be the probable cause of this condition?

a) Cirrhosis
b) Chylous acitis
c) Pancreatic ascitis
d) Peritoneal malignancy
e) Tuberculosis peritonitis

Q:13 The pseudomyxoma peritonei is a rare condition, occurs more frequently in

women, in which the abdomen is filled with large quantities of yellow jelly
material. This condition is usually associated with:

a) Desmoid tumour of peritoneum

 b) Mucinous adinocarcinoma of colon
c) Mucinous adenocarcinoma of stomach
d) Primary mucinous appendiceal tumour
e) Tuberculous peritonitis

Q:14 The mesenteric cysts occurs in the mesentery of the small intestine or the
colon are of various types. Which of the following is the most common variety,
frequently occurring in the mesentery of ileum?

a) Chylolymphatic cyst
b) Dermoid cyst
c) Hydatid cyst
d) Enterogenous cyst
e) Urogenital cyst

Q:15 Among the different varieties of mesenteric cysts, which of the following
have a common blood supply to the cyst wall and the bowel with which it is in
contact, therefore surgical removal of cyst always needs resection of the related
portion of intestine?

a) Chylolymphatic cyst
b) Dermoid cyst
c) Hydatid cyst
d) Enterogenous cyst
e) Urogenital cyst

Q:16 The retroperitoneal sarcomas are rare tumours accounting for only 1-2 % of
all solid malignancies: Among those, the most common variety of primary
retroperitoneal tumour is:

a) Leiomyosarcoma
b) Liposarcoma
c) Lymphosarcoma
d) Malignant histiocytoma
 e) Neurofibro sarcoma

Esophagus
Q: 17 The term odynophagia refers to:

a) Dysphagia for solids

b) Dysphagia for liquids
c) Gastro esophageal reflux
d) Pain on swallowing
e) Regurgitation

Q:18 Which of the following modality of investigations is most widely used to

diagnosed oesophageal motility disorder?

a) Barium swallow
b) Endoscopic ultrasound
c) Oesophagoscopy
d) Oesophageal manometry
e) 24 hour PH monitoring

Q:19 The most common cause of oesophageal perforation is?

a) Barotrauma (spontaneous perforation)

b) Bullet (FAI)
c) Foreign bodies
d) Instrumental/iatrogenic (Therapeutic endoscopy)
e) Stab injury (knives)

Q:20 Gastro oesophageal reflux disease is commonly caused by:

a) Achalasia
 b) Barret’s oesophagus
c) Corrosive
d) Loss of competence of the lower oesophageal sphincter (LOS)
e) Para oesophageal hiatus hernia (Rolling)

Q:21 Barrett’s oesophagus is a metaplastic change in the lining mucosa of the

lower oesophagus, usually occurs in response to:

a) Achalasia
b) Chronic gastro-oesophageal reflux
c) Corrosive injury
d) Drug induced
e) Excessive intake of beverages

Q:22 In Barret’s oesophagus there is an increased, about 25 times risk of

developing which of the following conditions?

a) Adenocarcinoma
b) Bacterial oesophagitis
c) Fungal oesophagitis
d) Squamous cell carcinoma
e) Transitional cell carcinoma

Q:23 When Barrett’s oesophagus is diagnosed, the most preferable treatment of

choice is:

a) Argon-beam plasma coagulation

b) Endoscopic mucosal resection (EMR)
c) Laser therapy
d) Medical treatment of the underlying gastro-oesophageal reflux with
surveillance endoscopy
e) Photodynamic therapy

Q:24 The para oesophageal (rolling) hiatus hernias, in which the cardia remains in
its normal anatomical position are rare. The best method of diagnosis is:
 a) Barium meal
b) CT scan abdomen
c) Plain X-Ray chest
d) Plain X-Ray abdomen
e) Ultrasound upper abdomen

Q:25 Symptomatic paraoesophageal (rolling) hiatus hernia are potentially

dangerous. The best management option is:

a) Always require surgical repair

b) Avoid smoking, excessive consumption of alcohol, tea of coffee
c) Endoscopic laser therapy
d) Endoscopic photo dynamic therapy
e) High-dose of PPI treatment

Q:26 The incidence of oesophageal cancer varies more than that of any other
cancer. The squamous cell cancer is endemic and the highest incidence in the
world occurs in:

a) Afghanistan
b) Africa
c) China
d) Iran
e) Pakistan

Q:27 A 60 years male presented with progressive dysphagia and remarkable

weight loss since 2 years. What is the best first-line investigation you suggest to
this patient for the diagnosis?

a) Blood tests including CBC,LFT

b) CT scan chest and abdomen
c) MRI chest
d) Oesophagoscopy and biopsy
e) Ultrasound abdomen
Q:28 The histopathological variety of adenocarcinoma of the oesophagus usually
occurs in:

a) Pharyngo-oesophageal junction
b) Upper 1/3rd of oesophagus
c) Middle 1/3rd of oesophagus
d) Lower 1/3rd of oesophagus
e) Whole length of the oesophagus

Q:29 Achalasia is defined as failure of the lower oesophageal sphincter (LOS) to

relax, causing dilated oesophagus. A firm diagnosis is usually established by:

a) Barium swallow
b) Contrast CT chest
c) Endoscopy
d) Endoluminal ultrasound
e) Oesophageal manometry

Q:30 Which of the following modalities of treatment is the best for achalasia in
young age:

a) Botulinum toxin
b) Drugs-calcium channels antagonists
c) Endoscopic laser therapy
d) Pneumatic dilatation
e) Surgery Heller’s myotomy

Q:31 A middle aged woman presented with H/O dysphagia associated with iron
deficiency anaemia, glossitis and koilonychia. The most probable diagnosis would
be:

a) Achalasia
 b) Carcinoma oesophagus
c) Crohn’s oesophagitis
d) Oesophagitis due to candida albicans
e) Plummar-vinson syndrome

Stomach and duodenum

Q:32 The common site of duodenal ulcer is in the 1st part of duodenum. When
ulcer occurs in the posterior wall of duodenum, the common complication could
be bleeding by involving which of the following vessels:

a) Gastroduodenal artery
b) Left gastric artery
c) RT gastric artery
d) RT gastro epiploic artery
e) Superior pancreaticoduodenal artery

Q:33 In the body of the stomach, HCl is produced by:

a) Chief cells
b) D cells
c) Enterochromaffin-like cells
d) G cells
e) Parietal cells

Q:34 Prolonged use of non-steroidal anti inflammatory drugs (NSAIDS) can cause
peptic ulcer by:

a) Breakdown of gastric mucous barrier

b) Stimulating G cells to produce Gastrin which acts on parietal cells to secrete
HCL
c) Stimulating ECL cells to produce histamine which acts on parietal cells to
produce HCL
d) Releasing acetylcholine from the nerve endings to stimulate gastric acid
secretion
 e) Stimulating neuropeptides release which act on parietal cells to produce
HCl

Q:35 For the diagnosis of upper gastrointestinal tract pathological lesions, which
of the following is considered as gold standard investigation?

a) Barium contrast radiology

b) CT scan upper abdomen
c) MRI
d) Endoscopy
e) Ultrasound upper abdomen

Q:36 Over the last 30 years , helicobacter pylori has proved to be an important
aetiological factor for common gastrointestinal disease. The sufficient
epidemiological data support the association of H.pylori with:

a) Type A gastritis
b) Type B gastritis
c) Erosive gastritis
d) Reflux gastritis
e) stress gastritis

Q:37 The most frequent site for peptic ulcers is:

a) Fundus of the stomach

b) Greater curvature of the stomach
c) 1st part of the duodenum
d) 2nd part of the duodenum
e) 3rd part of the duodenum

Q:38 The treatment of choice for uncomplicated peptic ulcers is:

 a) H.pylori Eradication therapy with PPI
b) Billroth II gastrectomy
c) Gastrojejunostomy
d) Highly selective vagotomy and drainage
e) Truncal vagotomy and drainage

Q:39 The common complication of duodenal ulcer is :

a) Bleeding
b) Duodenitis
c) Malignancy
d) Perforation
e) Stenosis

Q:40 The most common site of peptic ulcer perforation is in the:

a) Anterior aspect of the 1st part of the duodenum

b) Antrum of the stomach
c) Body of the stomach
d) Greater curvature of the stomach
e) Posterior aspect of the 1st part of duodenum

Q:41 Which of the following is the investigation of choice for the diagnosis of
suspected perforated peptic ulcer, in case of patient presented with signs of
peritonitis?

a) CT scan abdomen
b) Plain X-ray abdomen erect posture
c) Stool for H.pylori
d) Serum amylase
e) Ultrasound abdomen
Q:42 A 40 years male, smoker having H/O recurrent dyspepsia, presented in
emergency with signs of peritonitis. The most probable diagnosis is perforated
duodenal ulcer with free air under rt dome of diaphragm on plain x-ray abdomen
erect. The best treatment option is:

A) Medical treatment with omeprazole & H Pylori eradication for 2 weeks

B) Observation and conservative management with NPO, antibiotics,
omeprazole & IV fluids
C) Emergency laparotomy and omentoplasty
D) Emergency laparotomy and Bilroth II gastrectomy
E) Emergency laparotomy and subtotal gastrectomy with Roux-en-Y
reconstruction

Q:43 Upper gastro intestinal haemorrhage is a major medical problem,

commonly associated with NSAID use. The most common cause of bleeding is:

a) Gastric erosions
b) Mallory- Weiss tear
c) Oesophageal erosion
d) Oesophageal vaccine
e) Peptic ulcer

Q: 44 The most common site of bleeding from a peptic ulcer is:

a) Anterior aspect of the 1st part of duodenum

b) Posterior aspect of the first part of duodenum
c) Antral part of the stomach
d) Lesser curvature of the stomach
e) Body of the stomach near greater curvature
Q:45 In bleeding peptic ulcers, which of the following is the most appropriate
method of controlling haemorrhage after resuscitation?

a) Angiography with transcatheter embolisation

b) Endoscopic band ligation
c) Medical treatment with PPI and tranexamic acid
d) Open surgical control of bleeding
e) Therapeutic endoscopy with a combination of adrenaline injection or
clips.

Q:46 The most common cause of gastric outlet obstruction in old age is:

a) Duodenal stenosis secondary to healing duodenal ulcer

b) Gastric carcinoma
c) Gastric polyp
d) Pyloric stenosis secondary to pyloric ulcer
e) Pyloric mucosal diaphragm

Q:47 In gastric outlet obstruction, patient become dehydrated with profound

metabolic abnormalities. The best fluid for rehydration and correction of
electrolytes imbalance in this condition is:

a) Intravenous 5% dextrose water

b) Intravenous 10% dextrose water
c) Intravenous normal saline with potassium supplement
d) Intravenous plasma expander (Haemacel)
e) Intravenous Ringer’s lactate
Q:48 The most common mode of spread of carcinoma of the stomach is through
transperitoneal route, when the tumour reached the serosa. The term
krukenberg’s tumour is described as when the gastric carcinoma spread through
peritoneum and involve the:

a) Greater omentum
b) Liver
c) Ovaries
d) Spleen
e) Transverse colon

Q:49 The preoperative resectability of carcinoma of the stomach is best assessed

by:

a) Barium study
b) CT scan with contrast
c) Endoscopy
d) Endoluminal ultrasound
e) Ultrasound abdomen

Q:50 The operation of choice for resectable carcinoma of the stomach is:

a) Billroth-II gastrectomy
b) Sub-total gastrectomy
c) Total gastrectomy
d) Radial gastrectomy
e) Palliative procedure- gastroenterostomy (B&L 26th ed: 1054)

Q:51 Gastrointestinal stromal tumour (GIST) may arise in any part of the GIT, but
more than 50% are found in the:

a) Oesophagus
 b) Stomach
c) Duodenum
d) Small intestine
e) Large intestine (B&L 26th ed: 1054)

Q:52 Which of the following is the most common cause of duodenal obstruction
in adults?

a) Ca head of the pancreas

b) Annular pancreas
c) Neuro endocrine tumour (Gastrinoma)
d) Periampulary adenocarcinoma
e) Primary duodenal cancer (B&L 26th ed: 1055)

Q:53 Which of the following bariatric surgical procedure is the most commonly
performed worldwide for obesity?

a) Biliopancreatic diversion
b) Gastric banding
c) Gastric bypass surgery
d) Minigastric bypass surgery
e) Sleeve gastrectomy (B&L 26th ed: 1061)

Liver
Q:54 During surgical approach to liver trauma, what is pringle manoeuver to be
applied in profuse bleeding from the liver?

a) Compression of the liver with packs and correction of coagulopathy

b) Manual occlusion of vascular in flow by placing atraumatic clamp or
fingers across the foramen of winslow.
c) Applying large abdominal packs around the liver and removed after 48
hours.
d) Primary repair of stab incision in the liver with fine absorbable suture
 e) Portal vein injury repair with 5/0 prolene
(B&L 26th ed:1073)

Q:55 The most common/frequent organ injured in blunt abdominal trauma is:

a) Duodenum
b) Kidney
c) Liver
d) Mesentery
e) Spleen (B&L 26th ed: 1072)

Q:56 Oesophageal varices usually present with the acute onset of a large volume
haematemesis, caused by portal hypertension in liver cirrhosis. After resuscitation
the best method of arresting bleeding is:

a) Blood transfusion
b) Endoscopic band ligation combined with vasoconstrictors.
c) Splanchnic vasoconstrictors by vasopressin
d) Transjugular intra hepatic portosystemic stent shunts (TIPSS)
e) Vitamin-K 10mg intravenously (B&L 26th ed: 1075)

Q:57 Ascending cholangitis is an infection of the biliary tract usually associated

with obstruction, and patient presents with pain, fever and jaundice. The most
probable cause of this condition is:

a) As a complication of ERCP
b) Biliary stone disease
c) Cholangiocarcinoma
d) Primary biliary cirrhosis
e) Primary sclerosing cholangitis (B&L 26th ed: 1080)

Q:58 Hydatid cyst in the liver is a common condition, can occur after handling
with dogs. The causative agent is:
 a) Ascaris lumbricoides.
b) Entamoeba histolytica
c) Echinococcus granulosus
d) Enterobius vermicularis.
e) Liver fluke (B&L 26th ed: 1082)

Q:59 The most common type of liver tumour is:

a) Hepatoblastoma
b) Hepatocelluler carcinoma
c) Haemangio sarcoma
d) Intrahepatic cholangiocarcinoma
e) Liposarcoma (B&L 26th ed: 1085)

Spleen
Q:60 If elective splenectomy is planned in certain haemolytic disorders,
vaccination should be administered 2 weeks before surgery against which of the
following organisms?

a) E.coli, klebsiela, pseudomonas

b) Pneumococci, meningococci and H.Influenza
c) Streptococci and staphylococci
d) Typhoid and paratyphoid
e) Tuberculosis and brucellosis (B&L 26th ed: 1096)

Q:61 Among the following causes of splenomegaly, the most common indication
for splenectomy is:

a) Idiopathic thrombocytopenia purpura(ITP)

b) Leukaemia
c) Schistosomiasis
d) Tropical splenomegally
e) Tuberculosis (B&L 26th ed: 1095)
Q:62 Opportunist post splenectomy infection (OPSI) is a major concern after
splenectomy in young patients. Which of the following organisms are usually
responsible for this condition?

a) Clostridium tetani and welchii

b) E.coli and klebseila
c) Pneumococci and meningococci
d) Salmonella typhi and paratyphi
e) Streptococci and staphylococci (B&L 26th ed: 1096)

Q:63 Bile is produced by the liver and stored in the gallbladder from which it is
released in to the duodenum. About 95 percent of bile salts are reabsorbed in
which part of GIT, called as enterohepatic circulation?

a) Duodenum
b) Jejunum
c) Mid ileum
d) Terminal ileum
e) Ascending colon (B&L 26th ed: 1099)

Q:64 Bile is produced by the liver and stored in the gall bladder from which it is
released into the duodenum. What percentage of bile alts are reabsorbed from
terminal ileum through enterohepatic circulation?

a) 10%
b) 30%
c) 50%
d) 70%
e) >90% (B&L 26th ed: 1099)
Q:65 Gallbladder is a reservoir for bile. After taking meal, the sphincter of oddi
relaxes, gallbladder contracts and the bile enters the duodenum. These motor
responses of the biliary tract are mediated by:

a) Cholecystokinin
b) Gastrin
c) Histamine
d) Secretin
e) Somatostation (B&L 26th ed: 1099)

Q:66 In a 55 years female a difficult laparoscopic cholecystectomy was performed

for Gallstones and one drain was placed in sub hepatic space. On 2nd post
operative day bile was leaking in the drain tube. Which of the following
investigation you will advise to identify the source of bile leakage?

a) CT scan
b) MRCP
c) Precutaneous transhepatic cholangiography(PTC)
d) Radio isotope scanning (HIDA scan)
e) Ultrasound abdomen (B&L 26th ed: 1101)

Q:67 Endoscopic retrograde cholangio pancreatography (ERCP) is the method of

investigation for the assessment of hepatobiliary disorders. This technique is used
for:

a) Only diagnostic assessment in obstructive jaundice

b) Only therapeutic intervention in obstruction jaundice
c) Both a diagnostic and therapeutic modalities in biliary obstruction
d) Cannot identity the stones in CBD
e) Cannot assess the level of bile duct obstruction (B&L 26th ed: 1101)
Q:68 Gallstone are the most common biliary pathology. In what percentage of
patients these stones will be radio-opaque on plain X-Ray abdomen?

a) 1-2 %
b) 10%
c) 50-60%
d) 80%
e) More than 90% (B&L 26th ed: 1099)

Q:69 A plain X-Ray abdomen sometimes may show calcification of the

gallbladder, called porcelain gallbladder. The importance of this appearance is
associated with carcinoma of gallbladder in what percentage of cases?

a) <5%
b) 10%
c) 25%
d) 50%
e) More than 90 % (B&L 26th ed: 1099)

Q:70 Gallstones are the most common biliary pathology. Which of the following
is the initial investigation of choice for the diagnosis of gallstones?

a) Clinical examination
b) CT scan abdomen
c) HIDA scan
d) Plain X-Ray abdomen
e) Ultrasound abdomen (B&L 26th ed: 1099)

Q:71 In hepatobiliary disorders, courvoisier’s law is described in a patient as:

a) When patient develops pain RHC, Fever and jaundice

b) Jaundice may result if the stone migrated from the gallbladder and
obstructs the CBD
c) When gallstone causing bowel obstruction due to development of
cholecystoduodenal fistula.
 d) A palpable non-tender gallbladder in a jaundiced patient usually results
from CBD obstruction secondary to peripancreatic malignancy
e) A palpable non-tender gallbladder without jaundice results from complete
obstruction of the cystic duct due to stone impacted in neck of gallbladder

(B&L 26th ed: 1108)

Q:72 Post-cholecystectomy choledocholithiasis is best managed by:

a) Conservative treatment with intravenous antibiotics

b) ERCP with sphincterotomy and stone extraction
c) Laparoscopic choledochotomy and stone extraction
d) Open choledochotomy and stone extraction
e) Percutaneous transhepatic cholangiography and subsequent
choledochoscopy (B&L 26th ed: 1111)

Q:73 Primary sclerosing cholangitis is an idiopathic fibrosing inflammatory

condition of the biliary tree which affects both intrahepatic and extrahepatic
ducts. The causative factors could be immunological origin. There is a strong
association of this condition with which of the following disease?

a) Grave’s disease
b) Liver cirrhosis
c) Rheumatoid arthritis
d) SLE
e) Ulcerative colitis (B&L 26th ed: 1096)

Q:74 Malignant tumours of the biliary tree (cholangiocarcinoma) is a rare

malignancy (1-2%) of new cases in western countries. The major risk factor for
cholangiocarcinoma is :

a) Biliary-enteric anastomosis
b) Choledochal cyst
c) Hepatitis-C infection
d) Parasitic infection of biliary tree with Chlonorchis Sinensis
 e) Primary sclerosing cholangitis (B&L 26th ed: 1114)

Q:75 A 55 years female laparoscopic cholecystectomy was performed for

cholelithiasis. Biopsy report suggested adenocarcinoma confined to the mucosa
of the gallbladder (early stage disease). What further treatment you will advise?

a) Adjuvant chemotherapy
b) Adjuvant chemoradiotherapy
c) Close observation/follow up. No further treatment is indicated.
d) Radical en-bloc resection of the gallbladder fossa and surrounding liver
along with regional lymph nodes
e) Resection of the port site from where gallbladder was retrieved.

(B&L 26th ed: 1117)

Q:76 In carcinoma of the gallbladder which of the following tumour markers is

elevated in approximately 80 percent of patients?

a) Alpha-Fetoprotein
b) CA 19-9
c) CA 125
d) CEA
e) P-53 (B&L 26th ed: 1117)

Q:77 Gallbladder carcinoma is a rare disease, usually presents in the seventh or

eighth decades. Histopathologically the majority (90%) of cases are:

a) Adenocarcinoma
b) Adenolymphoma
c) Cholangiocarcinoma
d) Squamous cell carcinoma
e) Transitional cell carcinoma (B&L 26th ed: 1116)
 Pancreas
Q:78 The formation of portal vein by joining of superior mesenteric vein with the
splenic vein is located at the level of:

a) Behind the 2nd part of duodenum

b) Behind the head of pancreas
c) Behind the neck pancreas
d) Behind the body of pancreas
f) Behind the tail of pancreas (B&L 26th ed: 1125)
e)

Q:79 Acute pancreatitis is an acute condition presenting with upper abdominal

pain, usually associated with raised pancreatic enzyme levels in the blood or
urine. The most common cause of this condition is:

a) Alcoholism
b) Ampullary tumour
c) Gall stones
d) Post-ERCP
e) Viral infections (mumps) (B&L 26th ed: 1127)

Q:80 In severe upper abdominal pain if there is a doubt of acute pancreatitis, and
other causes of acute abdomen have to be excluded, which of the following is the
single best investigation for the diagnosis of acute pancreatitis?

a) Contrast enhanced CT scan

b) Endoluminal ultrasound
c) Plain X-Ray abdomen
d) Serum amylase level
e) Ultrasound abdomen (B&L 26th ed: 1128)
Q:81 The development of pseudopancreatic cyst is one of the local complication
after acute pancreatitis. If it is symptomatic, large (more than 6cm) and become
mature after 6 months, what is the standard protocol of its management?

a) Conservative treatment
b) Endoscopic tube drainage between the cyst cavity and the gastric lumen.
c) Laparoscopic cystogastrostomy
d) Percutanous drainage to the exterior under radiological guidance
e) Percutaneous transgastric cystogastrostomy. (B&L 26th ed: 1133)

Q:82 Which of the following variety of pancreatic cancer is more common > 85%?

a) Ampulary carcinoma
b) Ductal adenocarcinoma
c) Carcinoid tumour
d) Cystic adenocarcinoma
e) Neuro endocrine carcinoma (B&L 26th ed: 1137)

Q:83 A 60 years male presented with yellow discolouration of sclera, pruritis and
weight loss since 2-3years on examination he has deep jaundice and gallbladder is
palpable, non-tender. What is the most probable clinical diagnosis?

a) Carcinoma of the gallbladder

b) Carcinoma of the head of the pancreas
c) Hepatocellular carcinoma
d) Mucocele of the gallbladder
e) Porcelain gallbladder (B&L 26th ed: 1138)
Q:84 In carcinoma of head of the pancreas, when imaging shows that the tumour
is potentially resectable, which surgical procedure is more standard to be
performed?

a) Distal pancreatectomy
b) Pylorus-preserving pancreatoduodenectomy preserving the pylorus and
antrum
c) Stenting at ERCP
d) Total pancreatectomy
e) Whipple procedure including resection of antrum and pylorus (distal partial
gasterctomy) (B&L 26th ed: 1139)

Small & Large intestine

Q:85 Which of the following is the principle site of GIT for the absorption of bile
salts and vitamin-B12?

a) Duodenum
b) Jejunum
c) Terminal ileum
d) Ascending colon
e) Descending colon (B&L 26th ed: 1144)

Q:86 Which of the following is the principal site of GIT for the absorption of iron
and folate?

a) Stomach
b) Duodenum
c) Jejunum
d) Terminal ileum
e) Colon (B&L 26th ed: 1144)
Q:87 The principal function of the colon is:

a) Absorption of bile
b) Absorption of fat, protein and carbohyfrates
c) Absorption of iron and folate
d) Absorption of vitamin-B 12
e) Absorption of water (B&L 26th ed: 1144)

Q:88 Ulcerative colitis is an inflammatory bowel disease of the rectum and colon.
Which of the following investigations has a key role in diagnosis and management
of this condition?

a) Barium enema
b) Colonoscopy and biopsy
c) Contrast CT scan abdomen
d) Plain X-Ray abdomen
e) Stool specimen for microbiology (B&L 26th ed: 1147)

Q:89 A 55 years male has diagnosed as ulcerative colitis and was on medical
treatment since 2 years. His review colonoscopy and biopsy report reveals severe
dysplasia on histopathology. What is the best management option in this patient?

a) Continue medical therapy with 5-amino salicylic acid (5-ASA)

b) Add corticosteroids with 5-ASA
c) Add: Immunosuppresive agents with 5-ASA
d) Add monoclonal antibiotics with 5-ASA
e) Perform elective surgery after assessment by total proctocolectomy and
permanent end ileostomy (B&L 26th ed: 1149)
Q:90 The crohn’s disease is a chronic inflammatory bowel disease, can affect any
part of the GIT from mouth to the anal canal. The most commonly involved part
of GIT is:

a) Stomach
b) Jejumun
c) Terminal iliem
d) Colon
e) Rectum (B&L 26th ed: 1152)

Q:91 Typhoid fever is caused by salmonella typhi and patient usually presents
with fever and abdominal pain. The most common and frequent surgical
complication is:

a) Cholecystitis
b) Intestinal haemorrhage
c) Ileal perforation
d) Intestinal obstruction
e) Paralytic ileus (B&L 26th ed: 1157)

Q:92 Primary intestinal tuberculosis is hyperplastic variety, usually involves which

part of GIT?

a) Stomach
b) Duodenum
c) Jejunum
d) Ileo-caecal region
e) Recto sigmoid region (B&L 26th ed: 1158)
Q:93 A 30 years male presented signs and symptoms of intestinal obstruction
associated with weightloss and evening pyrexia. CT scan suggests thick walled
narrowed segment of terminal ileum and caecum with mesenteric
lymphadenopathy. Diagnosis probably is ileo-caecal tuberculosis. What is the best
management option?

a) Anti tuberculosis therapy

b) Surgery with limited Rt- hemicolectomy
c) Surgery with standard Rt-hemicolectomy
d) Surgery with extended Rt-hemicolectomy
e) Surgery with total proctocolectomy (B&L 26 th ed: 1158)

Q:94 A 25 years male presented with attacks of abdominal pain and intermittent
diarrhea associated with weightloss and evening pyrexia since 2-3 years. Clinical
examination reveals mild anaemia and a non-tender mass palpable in RIF. DRE
unremarkable. What is the most likely diagnosis?

a) Appendicular mass
b) Actinomycosis
c) Carcinoma of the caecum
d) Crohn’s disease
e) Ileo-caecal tuberculosis (B&L 26th ed: 1158)

Q:95 A 40 years male presented with diarrhea, abdominal pain and fever for 2
days. He is on antibiotics cephalosporin for skin and soft tissue infection since 10
days. His stool culture reveals clostridium difficile organisms isolated. What could
be the diagnosis?

a) Crohn’s disease
b) Intestinal ameobiasis
c) Intestinal tuberculosis
d) Pseudomembranous colitis
e) Ulcerative colitis (B&L 26th ed: 1159)
Q:96 Carcinoid tumour is one of the variety of neuroendocrine tumour, occurs
throughout the gastrointestinal tract. The most common site of its occurrence is:

a) Appendix
b) Duodenum
c) Colon
d) Ileum
e) Rectum (B&L 26th ed: 1160)

Q:97 Gastrointestinal stromal tumours (GIST) are the mesenchymal tumours,

most commonly found in the:

a) Oesophagus
b) Stomach
c) Small intestine
d) Colon
e) Rectum (B&L 26th ed: 1160)

Q:98 Familial adenomatous polyposis (FAP) is defined clinically by the presence of

more than 100 colorectal polyps. It is described as:

a) Is inherited as autosomal recessive condition

b) Is more common in males
c) The cancer develops after the age of 50 in untreated patients
d) The polyps develop throughout the colon and rectum early in the second
decade of life
e) The responsible gene is on the long arm of chromosome 6.

(B&L 26th ed: 1161)

Q:99 Which of the following is the investigation of choice for the diagnosis of
suspected colorectal cancer?

a) Double-contrast barium enema

b) Colonoscopy and biopsy
c) CT scan abdomen
d) Plain X-Ray abdomen erect
e) Ultrasound abdomen (B&L 26th ed: 1161)

Q:100 A double-contrast barium enema shows cancer of the colon as a constant

irregular filling defect, it is often described as:

a) Apple core appearance

b) Birds beak appearance
c) Cock screw appearance
d) Colon cut off sign
e) Rat tail appearance (B&L 26th ed: 1165)

__________________________________________________________________

Q:1 The best management option for carcinoma of the caecum or ascending
colon in Dukes-B stage is:

a) Chemoradiotherapy
b) Limited Rt: hemicolectomy
c) Standard Rt. Hemicolectomy
d) Extended Rt.hemicolectomy
e) Total colectomy (B&L 26th ed: 1166)
Q:2 Approximate five year survival for colorectal cancer with disease confined to
the bowel wall (Duke’s A stage) after surgical resection is:

a) 5 percent
b) 10 percent
c) 20 percent
d) 50 percent
e) 90 percent (B&L 26th ed: 1166)

Q:3 A Meckel’s diverticulum is a persistent remnant of the vetelointestinal duct

and present in about 2 percent of the population. It is found in the:

a) Duodenum
b) jejunum
c) Ileum
d) Caecum
e) Sigmoid colon (B&L 26th ed: 1168)

Q:4 In around 20 percent of cases, the mucosa of a Meckel’s diverticulum

contain’s heterotropic epithelium of:

a) Appendix mucosa
b) Bronchial mucosa
c) Gall bladder mucosa
d) Rectal mucosa
e) Stomach mucosa (B&L 26th ed: 1170)

Q:5 A temporary loop ileostomy is usually formed during which of the following
surgical procedure?

a) Abdominoperineal excision of the rectum

b) As part of a Hartmann’s procedure
c) Low anterior resection of rectum with coloanal anastomosis
d) After Rt.hemicolectomy and ileo-colic exteriorization
e) After distal partial gastrectomy in carcinoma of the stomach antrum

(B&L 26th ed: 1175)

Q:6 Permanent end colostomy is usually formed in which of the following surgical
procedure?

a) In Hartmann’s procedure
b) In abdominoperineal resection of rectum and anal canal
c) In Rt.hemicolectomy
d) In left hemicolectomy
e) In Paul-Mikulicz procedure (B&L 26th ed: 1175)

Q:7 Permanent end ileostomy is formed in which of the following surgical

procedures:

a) After abdominoperineal resection in Ca rectum and anal canal

b) After Hartmann’s procedure in Ca rectum
c) In Paul-Mikulicz procedure in sigmoid volvulus
d) After total proctocolectomy with ileo-anal poch construction in ulcerative
colitis
e) After panproctocolectomy with excision of whole colon, rectum and anal
canal in ulcerative colitis (B&L 26th ed: 1175)

Q:8 Enterocutaneous fistula is an abnormal connection between small bowel and

skin. The most common cause of this condition is:

a) After abdominal trauma

b) Crohn’s disease
c) As a result of radiotherapy
d) Carcinoma of caecum
e) Post operative leak from an anastomosis (B&L 26th ed: 1180)

Intestinal obstruction

Q:9 The most common cause of small bowel obstruction is:

a) Acute intussusceptions
b) Bands
c) Gut malignancy
d) Strangulated hernia
 e) Volvulus (B&L 26th ed: 1182)

Q:10 Acute intestinal obstruction may occur due to small bowel obstruction. The
most common cause of small bowel obstruction is:

a) Secondary to crohn’s disease

b) Secondary to carcinoma
c) Secondary to lymphoma
d) Secondary to tuberculosis
e) Secondary to sarcoma (B&L 26th ed: 1183)

Q:11 A 2 year old child presented with vomiting, abdominal distension and
passage of red currant jelly stool. What could be the most probable underlying
cause?

a) Acute intussusceptions
b) Intestinal adhesions
c) Malrotation of gut
d) Small bowel stricture
e) Strangulated inguinal hernia (B&L 26th ed: 1184)

Q:12 The most common site of intussusception in children is:

a) Ileo-ileal
b) Ileo-colic
c) Colo-colic
d) Colo-rectal
e) Colo-anal (B&L 26th ed: 1184)

Q:13 A volvulus is a twisting or axial rotation of a portion of bowel about its

mesentry. The most common site of its occurrence is:

a) Stomach
b) Small intestine
c) Caecum
d) Transverse colon
e) Sigmoid colon (B&L 26th ed: 1186)
Q:14 Intestinal volvulus is the torsion and twisting of bowel around its mesentery.
In sigmoid volvulus, a plain X-Ray abdomen shows which of the following
characteristic finding?

a) Apple core appearance

b) Bird beak sign
c) Claw sign
d) Coffee bean sign
e) Double bubble sign (B&L 26th ed: 1190)

Q:15 Intussusception is defined as one portion of the gut invaginated into an

immediately adjacent segment. The common site is ileocolic intussusception. In
barium enema, which of the following sign is diagnostic of this condition?

a) Apple core sign

b) Bird beak sign
c) Claw sign
d) Double bubble sign
e) O mega sign (B&L 26th ed: 1190)

Q:16 The best treatment option of recurrent intestinal obstruction caused by

adhesions is:

a) Charles-Phillip transmesenteric plication.

b) Intestinal intubation
c) Noble’s plication operation
d) Repeat adhesiolysis (enterolysis)
e) Prolonged conservative treatment with NPO, nasogastric aspiration,
Intravenous fluids and antibiotics (B&L 26th ed: 1193)

Q:17 Neonatal intestinal obstruction has many potential causes. The most
common cause is:

a) Congenital atresia or stenosis

b) Intestinal malrotation
c) Imperforate anus
 d) Hirschsprung’s disease
e) Meconium ileus (B&L 26th ed: 1193)

Q:18 Congenital intestinal atresia or stenosis is the most common cause of

intestinal obstruction in newborns. Which of the following is the most common
site of intestinal atresia?

a) Duodenal atresia
b) Jejunal atresia
c) Ileal atresia
d) Colonic atresia
e) Rectal atresia (B&L 26th ed: 1193)

Q:19 Meconium ileus is one of the cause of acute intestinal obstruction in

newborns. Which of the following is the underlying cause of this condition?

a) Cystic fibrosis
b) Hirschsprung’s disease
c) Intestinal atresia
d) Primary biliary cirrhosis
e) Polycystic kidney disease (B&L 26th ed: 1194)

Appendix

Q:20 The most common cause of acute abdomen in young adults is:

a) Acute Appendicitis
b) Acute Cholecystitis
c) Acute Gastroenteritis
d) Acute Gastritis
e) Acute Cystitis (B&L 26th ed: 1199)

Q:21 The most frequently performed urgent abdominal operation and often the
first major procedure performed by a surgeon in training is:

a) Appendicectomy
b) Cholecystectomy
 c) Cystolithotomy
d) Laparotomy for perforated peptic ulcer
e) Laparotomy for ileal perforation (B&L 26th ed: 1199)

Q:22 Appendix is a blind muscular tube, its base is attached to the caecum near
the terminal . What is the common anatomical position of the tip of the
appendix?

a) Pre ileal
b) Post ileal
c) Paracaecal
d) Pelvic
e) Retrocaecal (B&L 26th ed: 1199)

Q:23 Although neoplasm of the appendix is very rare, but once it occurs, which of
the following is the most common neoplasm of the appendix?

a) Adenocarcinoma
b) Carcinoid tumour
c) Lymphoma
d) Mucinous cystadenoma
e) Squamous cell carcinoma (B&L 26th ed: 1213)

Q:24 A 20 year young male presented with lower abdominal pain and tenesmus.
Per rectal examination reveals tenderness in the rectovesical pouch on the right
side. His TLC is also raised. Clinical diagnosis of acute appendicitis was made.
What could be the expected position of inflamed appendix in this patient?

a) Preileal
b) Post ileal
c) Para caecal
d) Pelvic
f) Retrocaecal (B&L 26th ed: 1203)
Q:25 In suspected case of acute appendicitis , by deep palpation of the left iliac
fossa, patient may experience pain in the right iliac fossa. This clinical sign is called
as?

a) Murphy’s sign
b) Obturator sign
c) Psoas sign
d) Rovsing’s sign
g) Pointing sign (B&L 26th ed: 1203)

Q:26 A 18 years male presented with pain in central abdomen, then shifted to RIF
after 4-6 hours. On clinical examination tenderness and rebound tenderness was
present in RIF. The diagnosis of acute appendicitis is essentially made on:

a) Clinical examination
b) Plain X-Ray abdomen
c) Ultrasound abdomen
d) CT scan abdomen
e) MRI (B&L 26th ed: 1206)

Q:27 Which of the following surgical incision is more cosmetically appropriate

when conventional appendicectomy is being performed ?

a) Grid iron incision

b) Lanz incision
c) Lower mid line incision
d) Right paramedian incision
e) Rutherford Morison incision (B&L 26th ed: 1208)

Q:28 A 12 years male presented with signs and symptoms of acute appendicitis
and conventional appendicectomy was decided. During surgery appendix is found
normal, what will be your further approach?

a) It is usual to remove the normal appendix only

b) Normal appendix is not to be removed
 c) It is usual to remove the normal appendix, to avoid the future diagnostic
difficulties, and exclude the other possible diagnosis of mickel’s
diverticulitis
d) Remove the appendix, extend the incision and examine the caecum and
ascending colon for suspected malignancy
e) Remove the appendix and extend the incision to examine the whole small
intestine for suspected tuberculous strictures. (B&L 27 th ed: 1312)

Q:29 An appendicular mass when diagnosed, what is the best management

option of appendicular mass?

a) Conservative treatment with ochner-sherren regime and 90% of cases

may resolve
b) Emergency appendicectomy
c) Conservative treatment, when resolved than always plan for interval
appendicectomy after 10 weeks
d) Conservative treatment, when failed then plan for right hemicolectomy
e) Emergency laparotomy and loop ileostomy (B&L 27th ed: 1312)

Q:30 What is the most common post-operative complication following

appendicectomy after 4th post operative day.

a) Adhesive intestinal obstruction

b) Basal atelectasis
c) Deep venous thrombosis
d) Portal pyaemia
e) Wound infection (B&L 27th ed: 1313)

Q:31 The most common site of carcinoid tumour is in the appendix. This tumour is
most frequently found in:

a) Base of appendix
b) Middle 3rd of the appendix
c) Distal 3rd of the appendix
d) Caecal wall
e) Commonly gives rise to metastases in the liver (B&L 27 th ed: 1315)
 Rectum

Q:32 The lymphatics of the rectal mucosa communicates freely with those of the
muscle layers. The usual lymphatic drainage flow of rectum is:

a) Anteriorly
b) Posteriorly
c) Upwards
d) Downwards
e) Lalerally (B&L 27th ed: 1319)

Q:33 The main arterial supply of the rectum is:

a) External iliac artery

b) Internal iliac artery
c) Inferior rectal artery
d) Middle rectal artery
e) Superior rectal artery (B&L 27th ed: 1319)

Q:34 For examination of the anorectal disorders, the patient is most conveniently
positioned in:

a) Jack knife position

b) Knee elbow position
c) Left lateral position
d) Lithotomy position
e) Prone position (B&L 27th ed: 1320)

Q:35 Internal haemorrhoids are best diagnosed by:

a) Digital rectal examination

b) Visual inspection of the perineum
c) Proctoscopy
d) Flexible sigmoidoscopy
e) Rigid sigmoidoscopy (B&L 27th ed: 1320)
Q:36 Rectal prolapse is classified as mucosal prolapse and complete rectal
prolapse (full thickness prolapse). Complete rectal prolapse is characterized as:

a) The mucus membrane and submuosa of the rectum protrude outside the
anus for approximately 1-4 cm.
b) All layers of the rectal wall protrude outside the anus more than 4cm,
usually associated with a week pelvic floor.
c) More commonly occurs in children
d) Digital repositioning is always advised
e) Injection sclerotherapy with 5% phenol in almond oil is the treatment of
choice. (B&L 27th ed: 1323)

Q:37 In complete rectal prolapsed, surgery is always required via a perineal or

abdominal approach. Which of the following procedure is recently gained
popularity with minimum post operative complications?

a) Delorme’s operation
b) Altemeier’s procedure
c) Laparoscopic sutured rectopexy
d) Laparoscopic anterior mesh rectopexy
e) Theirsch operation (B&L 27th ed: 1324)

Q:38 Colorectal cancer is one of the most common inherited cancer syndrome
known. Which is the most common initial gene mutation occurs in development
of colorectal cancer?

A) APC gene
B) TP 53
C) MSH 2
D) TGF- alpha
E) TGF- beta (B&L 27th ed: 1329)
Q:39 Carcinoma of the rectum can occur in young, but the common age of
presentation is usually above 55 years. Which is the most common and earliest
symptom of presentation?

A) Alteration in bowel habit

B) Bleeding per rectum
C) Pain
D) Tenesmus
E) Wight loss (B&L 27th ed: 1329)

Q:40 The most frequent site for blood-borne metastases in colorectal cancer is:

A) Adrenals
B) Brain
C) Bones
D) Liver
E) Lungs (B&L 27th ed: 1330)

Q:41 Which of the following histological type of rectal cancer grows rapidly,
metastasize early and have a poor prognosis?

A) Carcinoid tumor
B) Lymphoma
C) Malignant melanoma
D) Mucinous adenocarcinoma (signet-ring carcinoma)
E) Squamous cell carcinoma (B&L 27th ed: 1331)

Q:42 In Duke’s B stage of colorectal cancer, when the tumor involved

rectosigmoid & upper third of rectum, which of the following is the most
appropriate surgical option?

A) Abdominoperineal resection & permanent colostomy

B) Anterior resection & colorectal anastomosis
C) Hartmann’s operation
D) Low anterior resection & coloanal anastomosis
E) Transanal endoscopic microsurgery (TEMS) (B&L 27th ed: 1332)
 Anus and Anal Canal

Q:43 The internal sphincter of anal canal is an involuntary, thickened muscular

fibers, surrounding the anal canal. It is formed as a continuation of the:

A) Circular muscle coat of rectum

B) Coccygeus muscle fibers
C) Levator ani muscle
D) Longitudinal muscle fibers of the rectum
E) Puborectalis muscle sling (B&L 27th ed: 1340)

Q:44 The Dentate line is the wavy line of mucosa present in the anal canal. It is
the most important landmark both morphologically & surgically. It represents:

A) The junction between rectum & anal canal

B) A landmark between internal and external sphincter
C) A site of fusion of the proctodaeum and postallantoic gut and transition
of columnar epithelium to stratified squamous epithelium
D) A site of anorectal ring location
E) Usually disappears in old age (B&L 27th ed: 1340)

Q:45 The pilonidal sinus is a condition, lined by granulating tissue containing hair,
lying loosely within the lumen. The common site of its occurrence is:

a) Axilla
b) Inguinal region
c) Interdigital cleft
d) Natal cleft overlying the coccyx
e) Umbilicus (B&L 27th ed: 1347)

Q:46 An anal fissure (fissure-in-ano) is a longitudinal split in the anal mucosa of

the distal anal canal. What is the most frequent site of its occurrence

a) Anterior midline at 12 o clock position

b) Left lateral at 3 o clock position
c) Rt: lateral at 9 o clock position
d) Posterior midline at 6 o clock position
 e) Dual sites anterior and posterior midline (B&L 27th ed: 1350)

Q:47 After confirmation of the diagnosis of anal fissure and failure of conservative
management, the best surgical option is:

a) Anterior anal sphincterotomy

b) Anal advancement flap
c) Lateral anal sphincterotomy
d) Manual sphincter dilatation ( lord’s procedure)
e) Posterior anal sphincterotomy (B&L 27th ed: 1352)

Q:48 The most common and earliest symptom/presentation of haemorrhoids is:

a) Bleeding per rectum

b) Faecal incontinence
c) Lumps appear at the anal orifice during defecation
d) Painful defecation
e) Perineal itching (B&L 27th ed: 1356)

Q:49 Injection sclerotherapy is the non-surgical modality of treatment for certain

haemorrhoids. What is the best indication of this treatment?

a) 1st and 2nd degree haemorrhoids

b) 3rd degree haemorrhoids
c) 4th degree haemorrhoids
d) Interno-external haemorrhoids
e) Thrombosed haemorrhoids (B&L 27th ed: 1356)

Q:50 After haemorrhoidectomy, which of the following may be the early

complication noticed:

a) Anal stricture
b) Anal fissure
c) Faecal Incontinence
d) Reactionary haemorrhage
e) Secondary haemorrhage (B&L 27th ed: 1360)
Q:51 The management of acute perianal abcess is primarily surgical drainage of
pus. Which of the following most appropriate surgical incision is made over the
most fluctuant point of perianal skin?

a) Circumferential incision
b) Cruciate incision
c) Oblique incision
d) Transverse incision
e) Vertical incision (B&L 27th ed: 1363)

Q:52 A fistula in ano(anal fistula) is a chronic abnormal communication, usually

lined by granulation tissue, from anorectal lumen to an external opening on the
skin of the perineum. The majority of these fistulae are caused by:

a) Crohn’s disease
b) Lymphogranuloma venereum
c) Malignancy
d) Non-specific, anal gland infection
e) Tuberculosis (B&L 27th ed: 1363)

Q:53 A successful outcome after fistula surgery requires an accurate assessment

of the fistula itself, the sphincter through which it passes, and the risk of
incontinence. Which is the best method of assessment in recurrent fistula in ano?

a) Clinical examination
b) CT scan
c) Endoanal ultrasound
d) Fistulography
e) MRI (B&L 27th ed: 1365)

Q:54 The most common cause of anal stenosis is:

a) Inflammatory bowel disease

b) Irradiation stricture
c) Lymphogranuloma inguinale
d) Neoplastic
 e) Post-operative stricture after haemorrhoidectomy (B&L 27th ed: 1369)

Q:55 Anal stenosis is usually caused by as a complication after

haemorrhoidectomy, due to excessive removal of anoderm and mucosa. For
severe anal stenosis, which of the following is the best option of management?

a) Anal dilatation
b) Anoplasty
c) Colostomy
d) Lateral sphincterotomy
e) Non-operative treatment with fibre supplements and stool softeners

(B&L 27th ed: 1370)

Q:56 Anal malignancy is rare and accounts for less than 2% of the all large bowel
cancers. The most common histopathological type of anal malignancy is:

a) Adenocarcinoma
b) Lymphoma
c) Malignant melanoma
d) Sarcoma
e) Squamous cell carcinoma (B&L 27th ed: 1371)

Q:57 The squamous cell carcinoma of the anal canal is rare (<2%) of the large
bowel cancer. The incidence of this disease may arise, with a direct association of:

a) Crohn’s disease
b) Cytomegallo virus (CMV)
c) Human papilloma virus (HPV)
d) Lymphogranuloma venereum
e) Tuberculosis (B&L 27th ed: 1320)

Q:58 After assessment, the management of carcinoma of the anal canal is:

a) Abdominoperineal resection (APR)

b) Chemoradiotherapy
c) Laser ablation
 d) Low anterior resection
e) Local excision (B&L 27th ed: 1371)

Urology

Q:59 Testicular pain is acommon symptom in men, especially in early middle age.
Sudden severe testicular pain in young men (<30years) is most commonly caused
by:

a) Hydrocele
b) Epididymo orchitis
c) Scrotal abscess
d) Testicular torsion
e) Testicular tumour (B&L 27th ed: 1375)

Q:60 In urology department, the commonest indication of a plain X-Ray abdomen

and pelvis (KUB) is to diagnose:

a) Benign prostatic hyperplasia

b) Duplication of ureter
c) Renal cysts
d) Renal tumour
e) Urinary tract calculi (B&L 27th ed: 1388)

Q:61 A middle-aged male presented with haematuria in association with left loin
pain and a palpable mass in left loin. With this classic triad of symptoms and signs,
the most probable diagnosis is:

a) Hydronephrosis
b) Pyonephrosis
c) Psoas abscess
d) Pyelonephritis
e) Renal tumour (B&L 27th ed: 1375)
Q:62 A 55 years female presented with passage of air bubbles in the urine since 2
weeks. She is c/o mild lower abdominal pain and weight loss since 2 years. Her Hb
is 8gm%. What is the most probable diagnosis?

a) Bladder diverticuli
b) Cystocele
c) Colovesical fistula (CVF)
d) Urinary tract infection with gas forming organisms.
e) Vesicovaginal fistula (VVF) (B&L 27th ed: 1376)

Q:63 Which of the following is now the imaging modality of choice in the
investigation of a patient with suspected urinary tract calculi?

a) CT KUB
b) Intravenous urography (IVU)
c) MRI
d) Plain X-Ray abdomen (KUB)
e) Ultrasound (KUB) (B&L 27th ed: 1389)

Q:64 MRI has a significant role to play in the staging of urological cancers. Which
of the following suspected malignancy is to be best detected by MRI when other
imaging modalities fail to detect?

a) Bladder cancer
b) Prostate cancer
c) Renal tumour
d) Ureter tumour
e) Urethral tumour (B&L 27th ed: 1390)

Q:65 Ectopic ureters is a congenital disorder. It is described as:

a) More common in males

b) May cause incontinence in males
c) Never cause incontinence in females
d) Usually associated with duplex ureters
e) Usually drain the lower pole of the kidney (B&L 27 th ed: 1401)
Q:66 Urinary tract infection UTI more commonly involve the lower urinary tract.
Acute pyelonephritis is the infection of the of the renal pelvis characterized as:

a) Ascending infection is the most common route, due to urinary stasis by

calculi
b) Bladder tumour is the most common cause
c) Gram +ve cocci are commonly responsible
d) Haematogenous infection is the most common route
e) More common in males (B&L 27th ed: 1403)

Q:67 Genitourinary tuberculosis accounts 14% of non-pulmonary cases of TB. It is

characterized as:

a) Always secondary TB, caused by dissemination of the organism through

blood stream from pulmonary TB.
b) Always primary TB.
c) Hypertension is the early manifestation of renal TB.
d) Urine culture and sensitivity for tubercle bacilli is always negative
e) X-Ray KUB is more sensitive at identifying all manifestations of renal
tuberculosis

Q:68 The commonest urinary tract stones are:

a) Calcium oxalate
b) Calcium phosphate
c) Cystine
d) Magnesium ammonium phosphate
e) Uric acid (B&L 27th ed: 1407)

Q:69 A 30 years male presented with recurrent flank pain and fever with chills. His
TLC is raised and urea and creatine are slightly elevated CT KUB reveals 10m
stone in lower 3rd of ureter with moderate hydronephrosis. What is the best
treatment option?

a) Cystoscopy and insertion of ureteric stent

b) In situ extra corporeal shock wave lithotripsy (ESWL)
 c) Insertion of a percutaneous nephrostomy (PCN) under local anaesthesia
d) Medical treatment with NSAID, antibiotics and f-blockers
e) Primary ureteroscopic stone retrievel.

Q: 70 Extracorporeal shock wave lithotripsy (ESWL) is the common form of

treatment for renal calculi upto 1.5 cm in size. Which of the following urinary
calculi are relatively resistant to ESWL?

a) Calcium phosphate stones

b) Cystine stones
c) Magnesium ammonium phosphate stone
d) Struvite stones
e) Uric acid stones

Q:71 Extracorporeal shock wave lithotripsy (ESWL) is the common form of

treatment for renal calculi. Which of the following is contraindication to ESWL?

a) Patients having jaundice

b) Patients taking steroids
c) Patients on taking oral anticoagulants.
d) Patients having hypertension
e) Patients having bronchial asthma.

Q:72 Unilateral hydronephrosis is commonly caused by:

a) BPH
b) Idiopathic retroperitoneal fibrosis
c) Pregnancy
d) Urethral structure
e) Ureteric stone

Q:73 Which of the following I the investigation of choice for accurate assessment
of the extent of renal trauma.

a) CT scan abdomen with contrast

b) DTPA renal scan
c) Intravenous urography
 d) MRI
e) Ultrasound KUB

Q:74 Renal cell carcinoma is among the 10 most common cancers worldwide.
Which of the following type of renal tumour is most common?

a) Renal cell carcinoma

b) Chromophobe renal cell carcinoma
c) Papillary renal cell carcinoma
d) Transitional cell carcinoma
e) Wilm’s tumour (nephroblastoma)

Q:75 The most frequent cause of acute urinary retention in elderly is:

a) BPH
b) Acute urethritis or prostatitis
c) Neurogenic bladder
d) Urethral stricture
e) Urethral calculus

Q:76 What is best treatment for option for U-bladder stone size upto 2cm?

a) Extra corporeal shock wave lithotripsy (ESWL)

b) Intra corporeal shockwave lithotripsy
c) Open cystolithotomy
d) Percutaneous suprapubic litholapaxy
e) Perurethral litholapaxy

Q:77 Urinary bladder diverticula are characterized by:

a) More commonly occurs in females

b) Usually found in young age
c) The most common cause is bladder outflow obstruction
d) Neoplasm is the most frequent complication if not diagnosed earlier
e) Surgery is the treatment of choice even it is asymptomatic
Q:78 The most common aetiology of development of vesico vaginal fistula is:

a) As a complication of total hysterectomy

b) As a complication of anterior colporrhaphy
c) Direct infiltration of the carcinoma of cervix
d) Obstructed/neglected labour
e) Radiotherapy

Q:79 Lower urinary tract infection and cystitis is commonly occurs through:

a) Ascending infection from the urethra

b) Descending infection from the kidney
c) Haematogenous spread
d) Lymphogenous spread
e) Spread from adjoining , structures like vagina or gut

Q:80 The most common (90%) histological type of urinary bladder carcinoma
occurring is:

a) Adenocarcinoma
b) Clear cell carcinoma
c) Papillary carcinoma
d) Squamous cell carcinoma
e) Transitional cell carcinoma

Q:81 The most common presentation of urinary bladder carcinoma is:

a) Burning micturation
b) Bladder out flow obstruction
c) Painless gross haematuria
d) Supra pubic pain
e) Urinary urgency
Q:82 A 60 years male presented with gross painless haematuria since 1 week,
suspected bladder growth. Which of the following should always be advised as a
mainstay of diagnosis?

a) Contrast CT scan
b) Cystourethroscopy & biopsy
c) Intavenous urography
d) MRI
e) Ultrasound KUB

Q:83 The most commonly performed for BPH surgical procedure for correction of
bladder out flow obstruction (BOO) is:

a) Hotmium laser enucleation of the prostate

b) Perineal prostatectomy
c) Retropubic prostatectomy(RPP)
d) Trans urethral resection of prostate (TURP)
e) Transvesical resection of prostate

Q:84 Carcinoma of the prostate is the most common malignant tumour in men
over the age of 65 years. It usually originates in the:

a) Central zone of the prostate

b) Peripheral zone of the prostate
c) Transitional zone of the prostate
d) Prostatic urethra
e) Membranous part of urethra

Q: 85 The most common histological pattern of carcinoma of prostate is:

a) Adenocarcinoma
b) Adenolymphoma
c) Medullary carcinoma
d) Squamous cell carcinoma
e) Transitional cell carcinoma
Q:86 The most common site of distant metastasis by carcinoma of prostate is:

a) Brain
b) Lungs
c) Liver
d) Kidneys
e) Pelvic bones

Q:87 The bones involved most frequently by carcinoma of prostate are:

a) Femur
b) Humerus
c) Pelvic bone and lower lumbar vertebrae
d) Ribs
e) Skull

Q:88 In advanced carcinoma of prostate, the treatment of choice is:

a) Bilateral orchidectomy
b) Chemotherapy
c) Medical castration
d) Radical prostatectomy
e) TURP

Q:89 The most common congenital abnormality of the male urethra is:

a) Epispadias
b) Hypospadias
c) Posterior urethral valves
d) Urethral duplication
e) Urethral diverticulum

Q:90 The most common cause of urethral stricture among the following is:

a) Idiopathic
b) Pelvic fracture urethral injury
c) Secondary to urethral instrumentation or catheterization.
 d) Secondary to radical prostatectomy
e) Secondary to radiotherapy for prostate cancer

Q:91 In an undescended testis, orchidopexy is usually performed at the age of:

a) Before one year

b) At the age of 2 years
c) At the age of 3 years
d) At the age of 5 years
e) At the age of 7 years

Q: 92 Testicular torsion is a sudden twisting of the testicle in such a way that its
blood supply becomes compromised. It occurs most commonly:

a) In infants
b) At the age of 5-7years
c) At the age of 10-25 years
d) At the age of 35-40 years
e) In old age

Q:93 Varicoceles are common, affecting 15-20% of adult males and 90% are left
sided. The most common cause of this condition is:

a) Abscense of valves in the testicular vein.

b) Idiopathic
c) After left nephrectomy
d) Left renal tumour
e) After left epididymorchitis

Q:94 A hydrocoele is an abnormal collection of serous fluid in tunica vaginalis.

Acquired hydrocoeles are primary and secondary. A secondary hydrocoele is most
frequently associated with:

a) Acute or chronic epididymo-orchitis

b) Testicular trauma
c) Testicular torsion
d) Testicular tumour
 e) Varicocoele

Q:95 A hydrocoele is an abnormal collection of serous fluid in the tunica vaginalis.

A large and symptomatic hydrocoele usually requires treatment. What is the best
treatment option among the following?

a) Aspiration of the hydrocoele fluid

b) Injection sclerotherapy with tetracycline
c) Laser ablation
d) Surgery through scrotal incision
e) Surgery though inguinal incision