1.

45 year female under went laproscopic cholecystectomy, 1 month after sugery she developed
epigastric pain and jaundice, MRCP revealed stricture of the retropancreatic part of the CBD.

Supply from which of the following artery is likely impaired to cause the stricture:

a. Cystic artery
b. Gastrodoudenal artery
c. Hepatic artery
d. Retrodoudenal artery
e. Supradoudenal artery

Answer: Retrodoudenal artery

Ref: Sutton chp 24 pg 711

2. 50 yr male suffering from Carcinoma head of pancreas, underwent whipple’s procedure, his
post-op follow up CT scan of abdomen shows air in the biliary tract
What is the most likely cause in this patient:

a. Choledochojejunostomy
b. Diabetes Mellitus
c. Emphysematous cholecystitis
d. Reflux of air from sphincter of oddi
e. Roux-en-Y anastomosis

Answer: Choledochojejunostomy

Ref: Sutton chp 24 page 714

3. A 2 week baby boy has persistent jaundice with pale stools and bilirubin level of 12mg/dl,
On ultrasound there was non visualization of the gallbladder, and HIDA scan showed non
passage of the radionuclide in the small bowel, this condition is not associated with:

a. Absent IVC
b. Imperforate anus
c. Malrotation
d. Polysplenia
e. Situs inversus

Answer: Imperforate anus

 Ref: Sutton chp 24 page 720

4. 1 month baby presented with abdominal distention and tenderness in right upper quadrant,
Ultrasound showed ascites with complex periduodenal mass, excretion biliary scintigraphy
showed presence of the radionuclide in the peritoneum.

Most likely diagnosis is:

a. Bile duct tumor

b. Biliary atresia
c. Biliary stricture
d. Choledochal cyst
e. Spontaneous Perforation of bile duct

Answer : Spontaneous Perforation of bile duct

Ref: Sutton chap 24 page 722

5. 40 year gentleman presented with painless jaundice, having bilirubin level of 14mg/dl, and
raised Alkaline Phosphatase, Ultrasound showed moderate intrahepatic biliary dilatation, cause
of the obstruction could not be assessed, so CT abdomen was advised which showed subtle
enhancement of distal CBD with tapering.
The next step in the management will be

a. CT guided biopsy of lesion

b. ERCP with stenting
c. MRCP
d. PTC
e. Surgical management

Answer: ERCP with stenting

Ref: Sutton chap 24 page 732