Hepatobiliary pancreatic surgery Set I Review

Question Bank 2022
Practice online: www.shivankankakkar.weebly.com
Hepatobiliary Pancreatic Surgery - Set I
Document created: 02.15.2022 22:36 by Dr. Shivankan Kakkar, MD
Quiz Settings
Setting Value
Passing score: 50%
Total number of questions: 12
Number of questions to ask: 12
Answer submission: Submit one question at a time
Number of quiz retries: None
When quiz is finished: Show slide with results
Send quiz results to instructor: mbbsblues@gmail.com
Send quiz results to user: Yes
Intro Slide
NEET-PG Question Bank
Surgery
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Imported Questions (12/12 questions)
Question 1. Multiple Choice, 5 points, 1 attempt
Which of the following is the most common cause of pyogenic liver abscess?

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Correct Choices
Trauma
V Biliary tract infection
Colonic Diverticulitis
Appendicitis
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Correct: That's right! You chose the correct response.
Incorrect: You did not choose the correct response.
What is the diagnosis based on this ultrasound image?

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Correct Choices
V Simple Hepatic Cyst
HCC
Liver secondaries
Intrahepatic cholangiocarcinoma
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Correct:
Correct Answer: Simple Hepatic Cyst
• Contain serous fluid, do not communicate with the biliary tree, and do not have
septations
• Diagnosis: USG (Posterior acoustic enhancement)
Incorrect:
Correct Answer: Simple Hepatic Cyst
• Contain serous fluid, do not communicate with the biliary tree, and do not have
septations
• Diagnosis: USG (Posterior acoustic enhancement)
What is the most probable diagnosis on the basis of given endoscopy image?
Correct Choices
GAVE
Schatzki ring
Barrett's esophagus
V Esophageal varices

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Correct:
Correct Answer: Esophageal varices
• Most significant clinical finding associated with Pulmonary hypertension (PHT) is
development of GE varices.
• Major blood supply to GE varices is anterior branch of left gastric or coronary vein.
• Variceal bleeding is leading cause of morbidity and mortality associated with PHT
• Approximately 30% of patients with compensated cirrhosis and 60% of patients with
decompensated cirrhosis have esophageal varices.
Incorrect:
Correct Answer: Esophageal varices
• Most significant clinical finding associated with Pulmonary hypertension (PHT) is
development of GE varices.
• Major blood supply to GE varices is anterior branch of left gastric or coronary vein.
• Variceal bleeding is leading cause of morbidity and mortality associated with PHT
• Approximately 30% of patients with compensated cirrhosis and 60% of patients with
decompensated cirrhosis have esophageal varices.
Classical triad of Budd-Chiari syndrome:
Correct Choices
Fever, jaundice, abdominal pain
Fever, ascites, jaundice
V Hepatomegaly, abdominal pain, ascites
Abdominal pain, jaundice, hepatomegaly
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Correct: That's right! You chose the correct response.
Incorrect: You did not choose the correct response.

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A 61-year-old alcoholic man presents with a 6X6 cm mass in segment VII of liver. Imaging is suggestive
of right portal vein invasion. The serum bilirubin is 6 mg/dl, albumin level is 2.6 g/dl, Prothrombin Time
of 6 secs with moderate ascites but no signs of hepatic encephalopathy. He has been bed ridden for the
past 2 months and can only carry out his daily basic activities. What will be the most appropriate
management of this patient?
Correct Choices
Percutaneous ethanol ablation
Transarterial chemoebolization
CVP guided resection of the mass
V Sorafenib therapy
Feedback
Correct:
Correct Answer: Sorafenib therapy
As per Barcelona clinic classification, the patient falls into the advanced stage of
malignancy (category c); portal vein invasion+, child pugh B, ECOG 1/2. Hence, the best
line of management for him would be sorafenib therapy.
Incorrect:
Correct Answer: Sorafenib therapy
As per Barcelona clinic classification, the patient falls into the advanced stage of
malignancy (category c); portal vein invasion+, child pugh B, ECOG 1/2. Hence, the best
line of management for him would be sorafenib therapy.
All are true about hepatoblastoma except

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Correct Choices
Present in childhood
V Common in cirrhosis of liver due to HBV
Chemosensitive
Surgical resection is treatment of choice
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Correct:
Correct Response: Common in cirrhosis of liver due to HBV.
Cirrhosis caused by HBV is not a risk factor for the disease.
Hepatoblastoma is common in children and low birth weight, beckweith Weidman
syndrome, Familial adenomatous polyposis are the risk factors.
Hepatoblastoma is the most common malignancy of liver in childhood.
Hepatoblastoma is chemosensitive and responds to Vincristine, Cisplatin and 5-FU.
Mainstay of treatment is surgical resection of the tumor, chemotherapy is given as an
adjuvant agent.
Incorrect:
Correct Response: Common in cirrhosis of liver due to HBV.
Cirrhosis caused by HBV is not a risk factor for the disease.
Hepatoblastoma is common in children and low birth weight, beckweith Weidman
syndrome, Familial adenomatous polyposis are the risk factors.
Hepatoblastoma is the most common malignancy of liver in childhood.
Hepatoblastoma is chemosensitive and responds to Vincristine, Cisplatin and 5-FU.
Mainstay of treatment is surgical resection of the tumor, chemotherapy is given as an
adjuvant agent.

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Veno-occlusive disease in hepatic vein is characterized by:
Correct Choices
Central Venous Congestion
V Hepatomegaly
Portal vein obstruction
Budd Chiari syndrome
Feedback
Correct:
Correct Response: Hepatolmegaly.
Veno-occlusive disease is a group of disorders in which hepatic venous outflow
obstruction is due to subendothelial sclerosis of the sublobular hepatic veins and terminal
hepatic venules within the liver. Because of hepatic venous outflow obstruction patient
develops hepatomegaly.
Incorrect:
Correct Response: Hepatolmegaly.
Veno-occlusive disease is a group of disorders in which hepatic venous outflow
obstruction is due to subendothelial sclerosis of the sublobular hepatic veins and terminal
hepatic venules within the liver. Because of hepatic venous outflow obstruction patient
develops hepatomegaly.
A 10-year-old girl presents with pain in the right hypochondrium, fever, jaundice and a palpable mass in
the right hypochondrium. The most probable diagnosis will be:

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Correct Choices
Hepatitis
Hepatoma
V Choledochal cyst
Mucocele gallbladder
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Correct:
Correct Answer is Choledochal cyst as in this question we have a patient who has pain in
right hypochondrium, fever jaundice and a palable mass. This classic triad of pain,
intermittent jaundice and palpable mass is present in 10 % of patients of cholydochal cyst.
Hepatitis has pain in right hypochondrium but it does not have a palpable mass, patients
can have hepatomegaly.
Hepatoma can present as a painless palpable mass but jaundice is not a common feature
in hepatoma.
Mucocele of gall bladder can present as palpable mass of gall bladder but presence of
jaundice is not a feature.
Incorrect:
Correct Answer is Choledochal cyst as in this question we have a patient who has pain in
right hypochondrium, fever jaundice and a palable mass. This classic triad of pain,
intermittent jaundice and palpable mass is present in 10 % of patients of cholydochal cyst.
Hepatitis has pain in right hypochondrium but it does not have a palpable mass, patients
can have hepatomegaly.
Hepatoma can present as a painless palpable mass but jaundice is not a common feature
in hepatoma.
Mucocele of gall bladder can present as palpable mass of gall bladder but presence of
jaundice is not a feature.
Which of the following is most common and malignant neuroendocrine tumour of pancreas?

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Correct Choices
Gastrinoma
Glucagonoma
V Insulinoma
VIPoma
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Correct:
Correct Answer: Insulinoma
Insulinomas are the most common pancreatic neuroendocrine tumor, but only l0% are
malignant.
Gastrin-producing tumor (gastrinoma) are the most common malignant pancreatic
neuroendocrine tumor.
Incorrect:
Correct Answer: Insulinoma
Insulinomas are the most common pancreatic neuroendocrine tumor, but only l0% are
malignant.
Gastrin-producing tumor (gastrinoma) are the most common malignant pancreatic
neuroendocrine tumor.
What is the treatment of choice for CA head of pancreas?

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Correct Choices
Radiotherapy
Chemotherapy+ Radiotherapy
V Whipple's Surgery
Resection of the entire pancreas with adjuvant chemotherapy
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Correct:
Correct Answer : Whipple's Surgery
Whipples operation (Pancreaticoduodenectomy) is the most commonly performed
operation for carcinoma of head of Pancreas.
Incorrect:
Correct Answer : Whipple's Surgery
Whipples operation (Pancreaticoduodenectomy) is the most commonly performed
operation for carcinoma of head of Pancreas.
Charcot's triad is defined by all of the following except:

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Correct Choices
Fever
V Gall stones
Jaundice
Pain
Feedback
Correct:
Correct Response : Gall stones
Cholangitis is due to partial or complete obstruction of the biliary tree with resulting bile
stasis and secondary bacterial or microbial infection of the biliary tree
Causes -
Common bile duct stones
Benign biliary stricture (primary sclerosing cholangitis)
Malignancy (head of pancreas adenocarcinoma, ampulla of Vater, bile duct tumors)
Chronic pancreatitis
Prosthesis or stents in the common bile duct
Features:
Charcot's triad - right upper quadrant pain, fever, jaundice Reynolds' pentad - right upper
quadrant pain, fever, jaundice, hypotension, and mental status changes (delirium, anxiety,
and coma)
Nausea and/or vomiting
Right upper quadrant tenderness (mild to moderate)
Incorrect:
Correct Response : Gall stones
Cholangitis is due to partial or complete obstruction of the biliary tree with resulting bile
stasis and secondary bacterial or microbial infection of the biliary tree
Causes -
Common bile duct stones

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Feedback
Benign biliary stricture (primary sclerosing cholangitis)
Malignancy (head of pancreas adenocarcinoma, ampulla of Vater, bile duct tumors)
Chronic pancreatitis
Prosthesis or stents in the common bile duct
Features:
Charcot's triad - right upper quadrant pain, fever, jaundice Reynolds' pentad - right upper
quadrant pain, fever, jaundice, hypotension, and mental status changes (delirium, anxiety,
and coma)
Nausea and/or vomiting
Right upper quadrant tenderness (mild to moderate)
Kasai operation:
Correct Choices
V Biliary atresia
Choledochal cyst
Hepatocellular carcinoma
Primary biliary cirrhosis
Feedback
Correct:
Correct Answer : Biliary atresia
Kasai operation is also known as hepatoportoenterostomy. Biliary atresia is currently MC
indication for pediatric liver transplantation.
Incorrect: Correct Answer : Biliary atresia

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Feedback
Kasai operation is also known as hepatoportoenterostomy. Biliary atresia is currently MC
indication for pediatric liver transplantation.
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Hepatobiliary pancreatic surgery Set I Review

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