Q.1 Which of the following is the most common cause of obstructive jaundice worldwide?
Pancreatic cancer
Choledocholithiasis
Hepatocellular carcinoma
Cholangiocarcinoma
Explanation - Choledocholithiasis (stones in the common bile duct) is the most common cause of obstructive jaundice worldwide. Malignancies like pancreatic cancer or cholangiocarcinoma are important causes but less common overall.
Correct answer is: Choledocholithiasis
Q.2 The 'Courvoisier’s law' states that a palpable gallbladder in a jaundiced patient is most commonly due to:
Gallstones
Pancreatic carcinoma
Hepatocellular carcinoma
Primary sclerosing cholangitis
Explanation - Courvoisier’s law suggests that in the presence of jaundice, a palpable gallbladder is unlikely to be caused by gallstones, and more likely due to malignancy, typically carcinoma of the pancreatic head.
Correct answer is: Pancreatic carcinoma
Q.3 What is the gold standard investigation for detecting common bile duct stones?
Ultrasound abdomen
MRCP
CT abdomen
Endoscopic ultrasound
Explanation - MRCP (Magnetic Resonance Cholangiopancreatography) is the gold standard non-invasive test for detecting CBD stones, offering high sensitivity and specificity without radiation.
Correct answer is: MRCP
Q.4 Which of the following is the most common benign liver tumor?
Hepatic adenoma
Hemangioma
Focal nodular hyperplasia
Cholangioma
Explanation - Hepatic hemangioma is the most common benign liver tumor, usually asymptomatic and detected incidentally on imaging.
Correct answer is: Hemangioma
Q.5 Which surgical procedure is considered the definitive treatment for symptomatic gallstones?
ERCP
Laparoscopic cholecystectomy
Open choledochotomy
Percutaneous drainage
Explanation - Laparoscopic cholecystectomy is the gold standard treatment for symptomatic gallstone disease due to its safety, efficacy, and shorter recovery time.
Correct answer is: Laparoscopic cholecystectomy
Q.6 A patient with chronic liver disease undergoes surgery. Which of the following scoring systems is most commonly used to assess prognosis?
APACHE II
Child-Pugh score
SOFA score
Glasgow coma scale
Explanation - The Child-Pugh score is used to assess prognosis and surgical risk in chronic liver disease patients.
Correct answer is: Child-Pugh score
Q.7 Which of the following is NOT a risk factor for hepatocellular carcinoma?
Chronic hepatitis B
Alcoholic cirrhosis
Non-alcoholic fatty liver disease
Cholelithiasis
Explanation - Cholelithiasis (gallstones) is not a recognized risk factor for hepatocellular carcinoma, whereas chronic hepatitis B, cirrhosis, and NAFLD are strong risk factors.
Correct answer is: Cholelithiasis
Q.8 What is the most common complication after laparoscopic cholecystectomy?
Common bile duct injury
Bleeding
Infection
Retained stones
Explanation - Although uncommon, bile duct injury is the most serious and feared complication after laparoscopic cholecystectomy.
Correct answer is: Common bile duct injury
Q.9 Which imaging modality is best for detecting hepatocellular carcinoma in a cirrhotic liver?
CT abdomen triple phase
Plain X-ray
Ultrasound
PET scan
Explanation - Triple-phase CT (or MRI) is best for detecting and characterizing hepatocellular carcinoma, as it demonstrates arterial enhancement and venous washout.
Correct answer is: CT abdomen triple phase
Q.10 Portal hypertension is best diagnosed initially by:
Upper GI endoscopy
Ultrasound Doppler
CT angiography
Liver biopsy
Explanation - Ultrasound Doppler is a non-invasive first-line investigation for portal hypertension, detecting portal vein diameter and flow changes.
Correct answer is: Ultrasound Doppler
Q.11 Which of the following is a common indication for liver transplantation?
Acute pancreatitis
Gallstones
Fulminant hepatic failure
Portal vein thrombosis
Explanation - Fulminant hepatic failure, chronic cirrhosis, and hepatocellular carcinoma are major indications for liver transplantation.
Correct answer is: Fulminant hepatic failure
Q.12 A 50-year-old male presents with fever, right upper quadrant pain, and jaundice. This triad is called:
Reynold’s pentad
Murphy’s triad
Charcot’s triad
Virchow’s triad
Explanation - Charcot’s triad (fever, jaundice, right upper quadrant pain) is characteristic of acute cholangitis.
Correct answer is: Charcot’s triad
Q.13 Reynold’s pentad includes Charcot’s triad plus:
Shock and renal failure
Hypotension and altered mental status
Ascites and varices
Hepatic encephalopathy and coagulopathy
Explanation - Reynold’s pentad (Charcot’s triad + hypotension and altered mental status) indicates severe cholangitis with septicemia.
Correct answer is: Hypotension and altered mental status
Q.14 The best initial treatment for a ruptured hydatid cyst of the liver is:
Albendazole only
ERCP
Emergency laparotomy
Observation
Explanation - Ruptured hydatid cyst is a surgical emergency, requiring urgent laparotomy and management of anaphylaxis risk.
Correct answer is: Emergency laparotomy
Q.15 What is the commonest site of gallstone impaction causing gallstone ileus?
Duodenum
Terminal ileum
Sigmoid colon
Jejunum
Explanation - Gallstone ileus usually occurs due to impaction at the terminal ileum, the narrowest part of the small intestine.
Correct answer is: Terminal ileum
Q.16 Which of the following is a contraindication to laparoscopic cholecystectomy?
Gallstone pancreatitis
Uncorrectable coagulopathy
Obesity
Previous abdominal surgery
Explanation - Severe uncorrectable coagulopathy is a contraindication due to high risk of bleeding, while obesity and previous surgeries are relative contraindications.
Correct answer is: Uncorrectable coagulopathy
Q.17 The Pringle maneuver is used in liver surgery to control bleeding from:
Hepatic veins
Inferior vena cava
Portal triad
Hepatic artery alone
Explanation - The Pringle maneuver involves clamping the hepatoduodenal ligament to control bleeding from the portal vein, hepatic artery, and bile duct.
Correct answer is: Portal triad
Q.18 The most common cause of liver abscess in developing countries is:
Pyogenic infection
Hydatid cyst
Amoebic infection
Tuberculosis
Explanation - In developing countries, amoebic liver abscess (caused by Entamoeba histolytica) is more common, while pyogenic abscess dominates in developed countries.
Correct answer is: Amoebic infection
Q.19 What is the first-line treatment for a symptomatic hepatic hemangioma?
Surgery
Radiotherapy
Observation
Chemotherapy
Explanation - Most hepatic hemangiomas are asymptomatic and require no intervention. Surgery is considered only for symptomatic or complicated cases.
Correct answer is: Observation
Q.20 The most common malignant liver tumor in children is:
Hepatoblastoma
Hepatocellular carcinoma
Angiosarcoma
Metastasis
Explanation - Hepatoblastoma is the most common primary malignant liver tumor in children, usually occurring before age 5.
Correct answer is: Hepatoblastoma
Q.21 Murphy’s sign is elicited in:
Acute appendicitis
Acute cholecystitis
Acute pancreatitis
Liver abscess
Explanation - Murphy’s sign is pain and inspiratory arrest upon palpation of the right upper quadrant, seen in acute cholecystitis.
Correct answer is: Acute cholecystitis
Q.22 Which vessel is most commonly injured during laparoscopic cholecystectomy?
Hepatic artery proper
Right hepatic artery
Cystic artery
Portal vein
Explanation - The cystic artery is the most commonly injured vessel during laparoscopic cholecystectomy.
Correct answer is: Cystic artery
Q.23 Klatskin tumor refers to:
Intrahepatic cholangiocarcinoma
Hilar cholangiocarcinoma
Distal bile duct carcinoma
Gallbladder carcinoma
Explanation - Klatskin tumor is a cholangiocarcinoma located at the hepatic hilum, involving the confluence of the right and left hepatic ducts.
Correct answer is: Hilar cholangiocarcinoma
Q.24 Which liver segment is most commonly resected in a left lateral segmentectomy?
Segment IV and V
Segment II and III
Segment VI and VII
Segment I and II
Explanation - Left lateral segmentectomy involves resection of segments II and III, commonly performed in living donor liver transplantation.
Correct answer is: Segment II and III
Q.25 Which of the following best describes the pathogenesis of primary biliary cholangitis?
Autoimmune destruction of intrahepatic bile ducts
Gallstone impaction
Viral infection of hepatocytes
Congenital malformation of bile ducts
Explanation - Primary biliary cholangitis is an autoimmune disease causing progressive destruction of small intrahepatic bile ducts, leading to cholestasis and cirrhosis.
Correct answer is: Autoimmune destruction of intrahepatic bile ducts