1. 1. Regarding to gallstone is/are true except:
A. The gallstone is less common in fair skin females.
B. Bile constituents can be found in every types of gallstone.
C. Pigment gallstone is most commonly found in the common biliary duct.
D. Cholesterol supersaturation in the gallbladder can be influenced by pH value of the gastric
emptying.
E. Cholesterol stone is large in size and solitary.
2. These statement is true about gallstones:
A. Cholesterol stone can be dissolved spontaneously through medical regimens.
B. Pigment tones can be caused by excessive packed red blood cell transfusion.
C. One of the gallstones complications is intestinal ileus as a result parasympathetic stimulation.
D. Acute cholecystitis is always secondary to infected gallstones.
E. Production of urease by Escherichia Coli will cause bile acid supersaturation.
3. Following these statements is/are true about Acute Pancreatitis except:
A. The presentations of Acute Pancreatitis can mimick the Dengue Shock Syndrome
B. The common abdominal pain in Acute Pancreatitis is boring pain.
C. The differential diagnosis for Acute Pancreatitis includes liver abscess and ascending cholangitis.
D. Cullen sign is defined as hemorrhagic discoloration of the paraumbilicus.
E. Periampullary tumor is one of the causes of Acute Pancreatitis.
4. All these statements are true about Acute Pancreatitis:
A. Spontaneous Bacterial Peritonitis (SBP) is the complication of Acute Peritonitis.
B. Gallstone present in the Ampulla of Vater can predispose to develop Chronic Pancreatitis.
C. Methanol cannot cause Acute Pancreatitis.
D. Excessive drinking of alcohol is the least common cause of Acute Pancreatitis.
E. MRCP is one of the predisposing factors to develop Acute Pancreatitis.
5. Patho-clinical changes in Acute Pancreatitis:
A. Acute Pancreatitis can cause calcium fatty necrosis.
B. There are no specific biochemical tests to diagnose Acute Pancreatitis.
C. Abdominal roentgenogram will show sentinel loop dilatation of the colon.
D. Serum lipase will be raised first and it is lasts longer compared to the amylase.
E. CT abdomen is necessary to differentiate Acute Pancreatitis from other serious intra-abdominal
condition including perforated ulcer.
6. Acute Pancreatitis can be diagnosed through:
A. Modified Ranson Criteria is currently used as diagnostic criteria for Acute Pancreatitis.
B. Modified Ranson Criteria and APACHE II can be used as prognostic prediction for Acute
Pancreatitis.
C. Serum Alanine Transaminase (ALT) should be more than 250 IU/L.

2. D. Ranson cruiteria still reliable after 48 hours patient’s presentation with Acute Pancreatitis.
E. Urea level is one of the components in Ranson Criteria.
7. Regarding gallstones;
A. Gallstone colic is a moderate pain caused by spasm of gallbladder.
B. Pigment stones consist of calcium bilirubinate
C. Courvoisier’s law states if the gallbladder is palpable in the presence of jaundice, the jaundice is
likely due to stones
D. Cholesterol stones can develop in women whom taken oral contraceptive pills
E. Existence of fistulous tract from gallbladder with stomach may predispose to gallstone ileus
8. Concerning pancreatitis;
A. It can be due to hypocalcemia
B. Cullen’s sign is bruising in the flank
C. Calcium higher than 2 mmol/L is a feature of severe pancreatitis
D. Oxygen less than 7.98 kPa is a feature of severe pancreatitis
E. TWCC higher than 16 x 109/L is a feature of severe pancreatitis
9. The statement below describes about pancreatic tumour
A. Most are benign
B. Periampullary carcinoma can be treated by a pancreaticoduodenotomy
C. Glucagonoma causes hypoglycaemia
D. Zollinger - Ellison syndrome is associated with recurrent peptic ulceration
E. Carcinoma is associated with thrombophlebitis migrans
10. Concerning cholelithiasis
A. Over 10% are calcified
B. Are common in patients with haemolytic disorders
C. Charcot’s triad is associated with acute cholecystitis
D. Gallstones increase the risk of bleeding disorders
E. They are associated with squamous cell cancer of gallbladder
11. Features of obstructive jaundice include
A. Pruritus caused by bile pigments
B. Increased alkaline phosphatase
C. Prolonged clotting time
D. Normal calibre bile ducts on ultrasound
E. Risk of renal impairment
12. Portal hypertension
A. Develops if the portal pressure ids over 5 mmHg
B. Can be associated with schistosomiasis
C. Can cause thrombocytopenia
D. Predisposes to the development of rectal varices
E. May be relieved by a transjugular intrahepatic shunt (TIPS)
13. Regarding hepatic tumours
A. Primary hepatocellular carcinoma is very common worldwide

3. B. Carcinoembryonic antigen is associated with hepatoma
C. Aflatoxin are common cause of hepatoma produced by Aspergillus flavus
D. Are associated with the use of oral contraceptives
E. Metastatic tumour are an unusual cause
14. Below are the risk factors for gallstones
A. Female
B. BMI < 23
C. Postmenopausal women
D. Age > 40 years
E. Vegetarian
15. Cystic duct stones
A. Follows the Courvisier’s law
B. Can develops mucocele
C. Patient presents with obstructive jaundice
D. Empyema is a known complication
E. It is not removable
16. Portal hypertension
A. Budd-Chiari syndrome is the cause of pre-sinusoidal obstruction
B. Patient can have exudative ascites
C. Bleeding from the caput medusae is common
D. Esophageal varices can mimicked PUD
E. Can cause pancytopenia
17. Causes of acute pancreatitis
A. Choledocholithiasis
B. Alcoholism
C. Penetrating abdominal injury
D. Post-ERCP
E. NSAIDs
18. Liver cirrhosis
A. Is a reversible condition
B. Characterized by fibrosis of the hepatic lobule with distortion of the normal architecture
C. Curative treatment is liver transplant
D. Patient presents with stigmata of chronic liver diseases
E. Can lead to HCC
19. The sphincter of Oddi
A. is contracted by cholecystokinin (CCK)
B. regulates the flow of bile into the duodenum
C. relaxes in response to gastrin
D. contracts in the interdigestive period
20. Bile

4. A. contains only water, bile acids and cholesterol
B. contains unconjugated bile acids
C. contains conjugated bilirubin
D. is required for the uptake of protein in the small intestine
E. is required to help emulsify fats in the stomach
21. Cullen’s sign may be seen in :
A. Cushing’s syndrome
B. Acute pancreatitis
C. Hirchsprung’s disease
D. Carcinoma of the pancreas
E. Peritonitis
22. Haemochromatosis is characterized by
A. yellow discoloration of the skin
B. Diabetes Mellitus resulting from insufficient insulin production
C. Liver enlargement
D. A genetic defect on chromosome 6
E. Saturation of the iron binding lactoferrin
23. The causes of acute pancreatitis include :
A. Post-ERCP
B. Azathioprine
C. Alcohol
D. NSAIDS
E. Gallstones
24. Regarding the pancreas;
A. ectopic pancreatic tissue may be found in the distal end of the oesophagus
B. Ranson’s criteria are used to stage chronic pancreatitis
C. Speckled calcification of pancreas may occur in chronic pancreatitis
D. Pseudocysts are usually multiple
E. Diabetic smokers have an increased risk of develop carcinoma head of pancreas
25. The following are potential complications of gallstones
A. acute pancreatitis
B. pancreatic cancer
C. ascending cholangitis
D. primary biliary cirrhosis
E. empyema of gallbladder
26. The followings is/are true of tumours of the liver
A. metastases are the commonest tumours seen in the liver
B. cirrhosis is a risk for hepatocellular carcinoma (HCC) whatever the cause
C. HCC are particularly sensitive to chemotherapy
D. Liver ultrasound will detect the majority of liver tumours
E. Hemangiomas are the commonest benign liver tumours
27. The following statements is/are true;

5. A. serum amylase is rarely normal in acute pancreatitis
B. ERCP may be useful in the diagnosis of acute pancreatitis
C. Pseudocyst is an uncommon complication of acute pancreatitis
D. Thromboplebitis migrans is associated with pancreatic cancer
E. Ascites occurs early in the course of pancreatic cancer
28. The followings is/are true of infection involving the biliary tract
A. bile within the biliary tree is usually sterile
B. septicemic shock with gram negative organisms can occur
C. a cholestatic picture may be seen biochemically
D. blood cultures are rarely positive
E. ERCP is a risk factor for cholangitis
29. Acute pancreatitis
A. Has overall mortality of 10 %
B. May be related to bendrofluazide
C. May be cause by seat belt trauma
D. Commonly cause by e.coli infection
E. Plasma amylase is good indicator of severity of inflammation
30. Raised plasma amylase
A. Maybe asymptomatic
B. May occur in rupture of ectopic pregnancy
C. May occur in renal impairment
D. Greater than 5 times normal only be caused by acute pancreatitis
E. In combination with gas in portal vein suggestive of intestinal ischemia
31. Carcinoma of pancreas
A. 85% of tumor are unresectable at the time of diagnosis
B. Overall 10 % 5 years survival.
C. Related to OCP usage.
D. CA-19-9 highly specific tumour marker
E. May present with peripheral neuropathy
32. Acalculous cholecystitis
A. Most commonly seen in middle age women with constipation
B. Is thought to be splanchnic ischemia
C. Treated by percutaneous Cholecystectomy
D. Usually caused by clostridium infection
E. Is realte dto gallbladdercarcinoma
33. Gallbladder stone
A. Mostly compose cholesterol
B. Pigment stone caused by increase excretion of polymerized conjugated billirubin
C. Are not a risk factor for the development of the gallbladder carcinoma
D. Usually radiopaque
E. Impacted in the Hartman’s pouch cause mucocele of the gallbladder
34. Acute pancreatitis

6. A. Diagnosed by elevated serum Lipase
B. Moderate severity when ranson score is 4
C. Periampulary Carcinoma is a known cause of it
D. ARDS is a known complication
E. Grey turner sign is indicative in haemorrhagic pancreatitis
35. Pancreatic carcinoma
A. Obstructive jaundice with passage of dark urine is the commonest presentation
B. Occur at head of gland more 85%
C. A ductal carcinoma in 90% of cases
D. Are solely detected by ultrasound
E. Most unsuitable for curative surgery
36. Non- surgical treatment of gallstone
A. Suitable for radioluscent stone less than 1cm
B. Usually achieved by 3 month ursodeoxycholic acid
C. May be undertaken by MTBE
D. Recommended by young patient awaiting for renal transplant
E. Has low incident of recurrent stone after medical dissolution
37. Cholangiocarcinoma
A. Represent 1% of all GIT cancer
B. Related to chlonorchis sinensis infection
C. Rarely associated with choledocholithiasis
D. Metastases early
E. Present with obstructive jaundice in 90 % of cases
38. Gallstone ileus
A. Usually follows iatrogenic fistulation of the gallbladder in to the GIT tract
B. Calculi usually impact in the proximal ileus
C. Usually produces complete obstruction
D. May produce in the biliary tree
E. Is most common in the < 60 years old
39. Regarding fistula
A. is an extending from blind ending abscess cavity
B. Healing is facilitated by recurrent infection
C. communication between 2 surfaces of epithelium
D. posterior type have multiple external opening
E. High bowel fistula a/w severe electrolyte imbalance
40. Familial Adenomatous polyposis
A. autosomal dominant.
B. pre-malignant
C. assoc with Crohn disease
D. Cause electrolytes imbalance
E. majority treated with coloctomy
41. Constipation is a/w

7. A. Opiates
B. Ammonium Hydroxide preparation
C. Hypothyroid
D. Diabetes Insipidus
E. Lactulose administration
42. Carcinoma of cecum
A. Presented early with bloody diarrhea
B. Presented by right hemicolectomy
C. caused microcytis hypochromic anemia
D. diagnosed by sigmoidoscopy
E. associated with chron’s disease
43. Volvolus
A. causes venous infarction
B. cause peritonitis
C. can be cured by barium enema
D. occur usually at sigmoid colon
E. usually occurs in young adult
44. Colorectal carcinoma
A. Low fibre diet is a predisposing factor
B. Sunsburst appearance is a characteristic in barium enema
C. Patient presented with rectal bleeding and altered bowel habit
D. Duke staging is a for prognosis
E. Adenocarcinoma is a common histological type
45. Ureteric obstruction due to calculus , IVU showed
A. Normal excretion on non affected kidney
B. Delayed exretion on affected kidney
C. Contraction on non –affected kidney
D. Normal ureteral diameter
E. Site of obstruction
46. Folley’s catheter
A. Must always do under aseptic technique
B. is 24 mm length
C. 24 mm diameter
D. 24mm extrenal circumference
E. is used for urethral cathetherisation in adult male
47. Renal Cell carcinoma
A. can cause painful haematuria
B. metasteses to the bone
C. metastases to IVC
D. can cause cannon ball metasteses
E. Is called Wilm’s tumour
48. Ca prostate

8. A. occur frequently in men > 65 years old
B. respond to testosterone therapy
C. can invade rectal wall.
D. produce osteosclerotic 2ndary bone deposit
E. spread to pelvic LN
49. Causes of acute testicular swelling
A. epiddiimo-orchitis
B. torsion of testis
C. hydrocele
D. seminoma
E. Varicocele
50. Ureteric stone
A. Produce pain that colicky in nature
B. should be surgically removed
C. as predominantly ‘ triple phosphate”
D. ESWL one of the treatment option
E. predispose to TCC ureter
51. Hypercalcemia can result
A. Renal stones
B. Polyuria
C. Constipation
D. Gall stone
E. Tetanus
52. Predisposing factor for renal calculi
A. Liver cirrhosis
B. Living or working in tropical climate
C. Thyrotoxicosis
D. Diabetes insipidus
E. Malnutrition
53. Hematuria in abdominal injury
A. Exploration of the kidney immediately
B. IVU is no value
C. CT scan abdomen should be performed
D. Ureteric avulsion should be treated with by reconstruction an stenting
E. concealed subcapsular hematoma can be treated conservatively
54. Renal transplantation
A. Only done in patient less than 50 years old
B. Kidney will be put extraperitoneally
C. Urine output is monitored for rejection
D. Immunosuppressant medication is given
E. Urinary tract infection is a relative contraindication
55. In acute pancreatitis

9. A. treatment with antibiotic is mandatory
B. DM is sequeale
C. Is treated conservatively
D. Laparotomy is indicated in acute hemorhhagic necrotising type
E. A normal serum amylase can exlude acute pancreatitis
56. ERCP
A. must be on general anesthesia
B. Containdicated in jaundice
C. Greater advantage than PTC
D. used to confirm pancreatitis
E. can be used to dx stricture of pancreatic duct
57. Ascending cholangitis a/w:
A. Fever
B. Jaundice
C. Gallstone
D. large intestine obstruction
E. cholangiocarcinoma
58. Acute choleycytitis
A. a/w gallstone
B. Antibiotic is based on C&S from lab Ix
C. Cholycystectomy ca be done later in convalescence stage
D. Laparoscopic cholycystectomy is Treatment of choice
E. empyema is one of its complication
59. Regarding the imaging of gallbladder
A. pt not need to be fasted
B. Cholesterol stone is radio-opaque
C. chronic cholycytitis is esily distinguished from ca gallbladder
D. chronic cholycystitis
E. Ca head of pancrease cancer usually presented with over distended gallbladder
60. Regarding hydrocele
A. is a pre-malignant
B. may occur after operation of hernia
C. occur in a tunica vaginalis
D. Cause infertility in reproductive age
E. is reducible
61. Regarding hydrochepalus
A. FTT is a features
B. VP shunt
C. classically divided into communicating and non-communicating
D. pre-malignant
E. delayed repair cause the impaired
62. HPS

10. A. due to failue development of deudenal
B. diagnosed clinically
C. Ramsted operation is the treatment
D. Causes severe electrolyte imbalance
E. Genetic predisposing
63. Intusseption
A. In neonate usual require resection of bowel
B. Can cause bowel obstruction
C. causes red current jelly
D. is a twisting of bowel
E. Is treated with barium enema
64. Umbilical Hernia in 1 year old baby
A. Resolved spontenoesly at age 2 yrs
B. can cause Malignant
C. due to incomplete form of umbilical ring
D. can cause incarcerated bowel as a complication
E. treated by mayo repair
65. Obsturctive jaundice in neonates
A. Bliary atresia is a cause
B. Can lead to liver damage
C. Can be treated with kasai
D. liver transplant is an option
E. indirect billirubin is elevated
66. Inguinal hernias
A. always direct
B. F> M
C. present with irritability and vomiting
D. incarcerated can be treated with TAXIS and sedation
E. premature baby
67. Hircprung disease
A. Common female than male
B. due to absence of ganglion aurbach’s plexus
C. can be treted by Duhamel operation
D. commonly occur at rectosigmoid junction
E. diagnosed ny barium male
68. Transportation of neonates from dictrict to referral hospital
A. Biochemical test are important as baseline Ix
B. fluid loss is a serious complication in gastrichisis and exomphalus
C. transport in incubator can cuse hypothermia
D. In moving ambulance nothing much can be done
E. Baby with TOF must be mechanically ventilated