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4. Head Injuries
a. More than 1 million people are seen in UK hospitals each year with head injuries
b. Skull X-rays can exclude an intracerebral haematoma
c. Raised intracranial pressure is associated with an increase in cerebral perfusion
d. Cushing's response consists of a rise in blood pressure and fall in heart rate
e. Pupillary dilatation usually occurs on the same side as the intracerebral haematoma
8. Regarding appendicitis
a. The risk of developing the illness is greatest in childhood
b. Mortality increases with age and is greatest in the elderly
c. 20% of appendices are extraperitoneal in a retrocaecal position
d. Faecoliths are present in 75-80% of resected specimens
Questions 11-20
11. Regarding crystalloid solutions
a. Normal saline contains 154 mmol sodium and 154 mmol of chloride
b. 3 litres of dextrose saline in a day will provide 90 mmol of sodium
c. 2 grams of potassium chloride is equal to 57 mmol of the salt
d. Hartmann's solution contains calcium and bicarbonate
e. The daily maintenance potassium requirement of a 40 Kg woman is about 40 mmol
Questions 21-30
21. Regarding anal fissures
a. 10% occur in the posterior midline
b. Multiple fissures suggest a diagnosis of tuberculosis or Crohn's Disease
c. 50% of acute fissures heal with the use of a bulking agent
d. Sphincterotomy has a success rate of over 90%
e. Sphincterotomy is associated with minor faecal incontinence in over 15% of patients
23. Fibroadenomas
a. Are benign monoclonal neoplasms
b. Most commonly present in late adolescence or the early 20s
c. Should be diagnosed by triple assessment
d. At least 30% reduce in size over a 2 year period
e. Can be safely managed conservatively
25. Warfarin
a. Reduces the concentration of vitamin A dependent clotting factors
b. Has a half life of about 36 hours
c. Crosses the placenta and should be avoided in pregnancy
d. Doses should be reduced in liver disease
e. An INR of between 2.0 and 3.0 is appropriate in the treatment of DVT
26. Heparin
a. Is a heterogeneous mixture of sulphated polypeptides
b. Potentiates the actions of antithrombin III
c. Has a half life of 12 hours
d. Can be reversed by protamine sulphate
e. Can induce an idiosyncratic thrombocytopenia
Questions 31-40
31. Infantile hypertrophic pyloric stenosis
a. Occurs with a male : female ratio of 4:1.
b. Sons of affected mothers have a 20% risk of developing the lesion
34. Phaeochromocytomas
a. Are neuroendocrine tumours of the adrenal cortex
b. Are benign in 90% of cases
c. Occur as part of the MEN type I syndrome
d. Can be imaged with a meta-iodobenzylguanidine scan
e. Require only beta-blockade prior to surgery
Questions 41-50
41. Regarding local anaesthesia
a. Local anaesthetics act on large before small nerve fibres
b. Their main toxic effects are seen on the central nervous and cardiovascular systems
c. Adrenaline reduces absorption and prolongs the local effects
d. Preparations containing adrenaline are safe to use on digits and appendages
e. Lignocaine has a longer duration of action than bupivicaine
Questions 51-60
51. Regarding the use of laxatives
a. Ispaghula husk (e.g. Fybogel) is a bulk forming agent
b. Lactulose is a glucose polymer
c. Lactulose is hydrolysed by bacteria in the small intestine
d. Senna is a GI stimulant that acts within 30 minutes
e. Laxative abuse can lead to hypokalaemia and colonic atony
60. Intussusception
a. Is most common in children from 6 to 12 years
b. Presents with colicky abdominal pain, rectal bleeding and an abdominal mass
c. 10% present with diarrhoea and vomiting suggestive of gastroenteritis
d. If no shock or peritonitis hydrostatic reduction can be attempted
e. A Meckel's diverticulum can induce an intussusception
Questions 61-70
61. Hirschsprung's disease
a. Is due to absent ganglion cells in Auerbach's plexus
b. 10% cases have involvement of the recto-sigmoid segment
c. 10% cases present with delayed passage of meconium in the first 24 hours after
birth
d. The affected segment of bowel appears dilated on barium enema
b. Folate deficiency
c. Thalassaemia minor
d. Hypothyroidism
e. Iron deficiency
a. The internal ring lies midway between the symphysis pubis and anterior superior iliac
spine
b. The internal ring lies medial to the inferior epigastric vessels
c. The external oblique aponeurosis forms the anterior boundary
d. The inguinal ligament forms the inferior boundary
e. The conjoint tendon forms the lateral part of the posterior wall
Questions 71-80
71. Coeliac disease
a. Results from dietary glucose intolerance
b. Is associated with increased serum anti-endomysial and anti-gliadin antibodies
c. Small bowel histology shows villous hypertrophy
d. Can be effectively treated with a gluten-free diet
e. Increases the risk of small bowel lymphoma
76. Cryptorchidism
a. Occurs in 5% of newborn boys
b. Increases risk of malignancy by a factor of ten
c. Is associated with normal fertility
d. Laparoscopy is the best means of identifying an impalpable testis
e. Should be treated by orchidopexy at puberty
Questions 81-90
81. Regarding gas gangrene
a. It is due to Clostridium botulinum infection
b. Clostridial species are gram-negative spore forming anaerobes
c. The clinical features are due to the release of protein endotoxin
d. Gas is invariably present in the muscle compartments
e. Surgical debridement and antibiotics are an essential part of treatment
90. Amyloidosis
a. Appears as extracellular basophilic hyaline material
b. Can be stained with Congo Red dye
c. Show an apple green birefringence in polarised light
d. Is a complication of medullary carcinoma of the thyroid
e. Is a complication of Hodgkin's disease
Questions 91-100
91. Ectopic pregnancy
a. Occurs in about 10% of pregnancies
b. The risk is increased in those with a history or pelvic inflammatory disease
c. Usually presents between 2 and 4 months of gestation
d. Patients usually have a negative pregnancy test
e. if shocked early laparotomy is essential
94. Tetanus
a. Is due to an infection with a gram-negative spore forming rod
b. The organism produces a powerful endotoxin
c. The toxin prevents the release of inhibitory neurotransmitter
d. Clostridium tetani is sensitive to penicillin
e. Risus sardonicus is the typical facial spasm