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Which of the following has been proven to be beneficial in severe pancreatitis:

  1. Somatostatin
  2. ERCP + stone removal
  3. TPN
  4. Ampicillin
  5. NG tube drainage

A 50 year old woman has an ultrasound for epigastric pain. Her GB is normal but she has a 5 cm echogenic lesion in the right lobe of her liver. All of the following are part of the workup EXCEPT

  1. Enhanced CT scan
  2. AFP level
  3. Nuclear study
  4. Needle biopsy of lesion
  5. Liver function tests

All are true regarding intrahepatic gallstones EXCEPT:

  1. cholecystectomy and CBD exploration is curative
  2. more common in Asia compared to North America
  3. may lead to hepatic fibrosis
  4. may require resection of affected lobe
  5. may lead to sepsis
  6. All the following are associated with jaundice due to hemolysis EXCEPT:

      1. hyperbilirubinemia
      2. decreased haptoglobin
      3. increased LDH
      4. increased ALP
      5. increased urine hemosiderin

Poor prognostic factors in cirrhotic for an operation EXCEPT:

  1. platelets < 70 000
  2. bilirubin > 30 (1-2-3 points)
  3. ascites (2-3 points)
  4. coma (three points on CPT)
  5. INR > 2 (2 points)

A patient undergoes renal transplant and is started on prednisone, cyclosporine, and azathioprine. 6 weeks later he returns with fever, mild elevation of liver transaminases, elevated creatinine to 175 (baseline 100). Cyclosporine level normal.

      1. rejection
      2. CMV infection
      3. Hepatitis C
      4. Drug toxicity
      5. Regarding intrahepatic stones, all except:

      6. cholecystectomy and CBDE is curative
      7. more common in Asia compared to North America
      8. may lead to Biliary cirrhosis
      9. hepatectomy if comfined to one lobe

Sclerosing cholangitis is associated with all except:

    1. UC
    2. Scleroderma
    3. Regional enteritis
    4. Reidels thyroiditis
    5. Retroperitoneal fibrosis

65 year old female with unresectable cholangiocarcinoma has an internal/external biliary stent placed. 3 weeks later presents with fever and melena.

    1. arteriobiliary fistula
    2. erosion into duodenum
    3. cholangitis
    4. acquired vitamin K deficiency

56 year old male presents with mild Biliary pancreatitis. CT shows complex cystic mass in body of pancreas. What should you do?

    1. MRCP
    2. ERCP
    3. CT-guided biopsy
    4. Distal pancreatectomy
    5. Cystenterostomy

Pancreatic divisum

    1. duct of Santorini does not empty into duodenum
    2. failure of ventral bud to migrate and join dorsal bud
    3. duct of Wirsung drains body, head, uncinate process
    4. duct of Santorini is main drainage of pancreas
    5. Highest risk of cancer in duodenum

        1. Adenomatous polyp
        2. Hamartomatous polyp
        3. Brunners gland polyp
        4. Peritoneal fluid normally is absorbed by

          1. parietal peritoneum
          2. visceral peritoneum
          3. lymphatics of diaphragm
          4. omentum

      Patient develops pleural effusion with high amylase after bout of pancreatitis. He has been treated medically for 3 weeks without resolution. What is next step?

    6. continue conservative medical management
    7. start IV somatostatin
    8. ERCP
    9. Pancreaticojejunostomy

48 hours post-op Laparotomy to remove packs following major liver trauma, patient has RUQ pain and guarding, fever 38.5C, WBC 13000. CT shows significant amount of subphrenic fluid. Diagnosis

                1. hematoma
                2. biloma
                3. abscess
                4. rupture liver

Worse perisplenic adhesions

    1. ITP
    2. Septic infarcts
    3. Hemolytic anemia
    4. None of the above

Regarding skin cancer post renal transplant. Which is true?

    1. more common on the back
    2. multiple lesions more common
    3. more common in females
    4. melanoma more common

Pancreatitis in patient that is doing well. CT shows fluid collection around pancreas, you should do the following:

    1. Precautious Drain
    2. Do nothing, and re-image in 2 weeks
    3. ERCP
    4. MRCP

What is proven to improve outcome in acute Biliary pancreatitis?

    1. NG decompression
    2. ERCP and stone extraction
    3. Somatostatin
    4. Peritoneal lavage
    5. Imipenum treatment

U/S for menorrhagia in female picks up 5 mm polyp in gallbladder. Which is true?

    1. in absence of gallstones, there is increased risk of malignancy
    2. must be resescted if polyp > 6 mm
    3. advocate watch and F/U with serial U/S
    4. must do cholecystectomy

Jaundiced and uremic patient with ongoing bleeding post liver biopsy. What is true?

    1. Hyperbilirubinemia is common cause of coagulopathy
    2. Cause of coagulopathy in uremia usually secondary to thrombocytopenia
    3. Normal PTT, PT rules out any coagulation factor deficiency except Factor XIII

35 year old renal transplant patient with left colon perforation 6h old.

    1. resection + primary anastomosis
    2. proximal stoma + drain
    3. resect and bring out stoma
    4. resect + primary anastosis + proximal stoma

Most common organism in splenic and liver abscess in immunocompromised

    1. Pseudomonas
    2. Candida
    3. E. Coli
    4. Klebsiella

U/S for vague abdominal pain shows 5 cm lesion anterior surface of right lobe liver in young female. What of the following in not part of initial Management include:

    1. CT with contrast
    2. CT guided Biopsy
    3. Colloid scan
    4. AFP level
    5. Liver enzymes
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