Welcome to Surgery Multiple Choice Questions

These questions have been compiled by me from various entrance exams. Answers and explanations  for the questions have been given. I have been working on this site since 2005. Earlier it used to be on geocities and other free servers. My thoughts of publishing a surgery mcq book  or for that matter surgery mcq pdf remain unpublished but then I bought this domain and have been working on this ever since.

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1 b – Primary Hyperthyroidism

Peptic ulcer is associated with a host of conditions.

It includes

Helicobacter pylori
Helicobacter heilmannii
Other rare infections: TB, syphilis, mucormycosis, etc
Hormonal or mediator-induced, including acid hypersecretory states
Gastrinoma (Zollinger-Ellison syndrome)
Systemic mastocytosis
Basophilia in myeloproliferative disease
Antral G cell hyperfunction (existence independent of H. pylori is debatable)
Drug exposure
NSAIDs and aspirin including low dose aspirin
Bisphosphonates (probably when combined with NSAIDs)
Clopidogrel (when combined with NSAIDs or in high risk subjects)
Corticosteroids (when combined with NSAIDs)
Spironolactone (probable, no data with NSAID cotherapy)
Mycophenolate mofetil
Potassium chloride
Chemotherapy (eg, hepatic infusion with 5-fluorouracil)
Post surgical
Antral exclusion
Post-gastric bypass
Vascular insufficiency including crack cocaine use
Mechanical: Duodenal obstruction (eg, annular pancreas)
Radiation therapy
Infiltrating disease
Crohn disease
Comorbid ulcers associated with decompensated chronic disease or acute multisystem failure
Stress intensive care unit ulcers
Organ transplantation
Renal failure
Chronic obstructive pulmonary disease (secondary to smoking)

Most frequent digestive manifestations of Primary Hyperthyroidism  are constipation, heartburn, nausea and appetite loss that occur in 33%, 30%, 24% and 15% of cases, respectively.

2. b

EUS is better than CT or any other diagnostic modality for diagnosis of carcinoma esophagus. C T scan only shows thickened esophagus wall in cases of carcinoma esophagus which is not specific for malignancy and also can not truly describe the extent of local disease.

The greatest inaccuracy of EUS in reporting the local extent for Ca esophagus is for T2 tumors. This is because for clinical assessment the fourth ultrasound layer is interpreted as the muscularis propria. This layer, however, does not include the interface between the submucosa and muscularis propria; it is contained in the third ultrasound layer. Thus, the border necessary to completely differentiate T1 from T2 tumors is contained in the third ultrasound layer. As two boundaries must be assessed for determination of T2 and errors might occur at each, the inaccuracy is potentially twice that of T1 and T4 tumors.

Ref Shakelford 6th edition , Chapter Endoscopic Esophageal Ultrasonography

Answer 3. d

A suspected case of cholangiocarcinoma should undergo evaluation to rule out benign biliary diseases and staging workup in cases of malignancy. Contrast MRI and MRCP are the initial investigations of choice. Hilar cholangiocarcinoma or Klatskin tumor is at the biliary confluence and causes dilatation of both intrahepatic ducts.

ERCP is not preferred for diagnostic purposes because

  1. It is invasive
  2. It fails to drain/stent some times leading to ascending cholangitis
  3. Brush cytology has a very low sensitivity (25-30%)

4. a

In laparoscopic CBD exploration there are two ways. One with less morbidity is the transcystic approach in which cystic duct is dilated and stones are removed through the cystic duct. After the procedure the cystic duct is clipped as in laparoscopic cholecystectomy. This  procedure has the least morbidity as CBD is not opened. Indications of Choledochotmy are
  • Unsuccessful transcystic exploration
  • CBD diameter more than 8 mm
  • Multiple large stones
  • Ampullary diverticulum on IOC
  • ERCP unavailable  or contraindication of ERCP
  • Previous Billroth II gastrectomy

- See more at: http://www.mcqsurgery.com/index11.html#sthash.IAz9zeJ2.dpuf


Dieulafoy's lesion of the stomach is not an uncommon cause of upper GI bleeding. Its incidence in all patients with upper GI bleed range from 0.3 to 7%. The cause of such bleeding is a large tortuous vessel in submucosa which leads to ulceration of the over lying mucosa. The lesions occur at 6-10 cm from the cardia near the GE junction. Endoscopy is the diagnostic modality of choice and lesion is controlled by electrocoagulation, heatre probes or photo coagulation

Ref Sabiston 19th edition page 1222


0.2-0.6 g of bile salts are secreted by liver each day in the form of cholic acid and dexoy cholic acid. Only 5% of bile salt is excreted per day and 95% is absorbed by the portal vein Bile is stored and concentrated in the gall bladder Gall bladder fills by retrograde mechanism by contraction of sphincter of oddi. - See more at: http://www.mcqsurgery.com/index11.html#sthash.IAz9zeJ2.dpuf