Questions 1-10

Questions 1-10

1. The following are absorbable suturesa. Catgut

b. Silk

c. Polyamide (Nylon)

d. Polyglyconate (Maxon)

e. Polyglactin (Vicryl)

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2. Peutz Jeghers Syndromea. Is an autosomal recessive condition

b. Often presents with anaemia in childhood

c. Is characterised by circumoral mucocutaneous pigmented lesions

d. Is associated with adenomatous polyps of the small intestine

e. Malignant change occurs in 2-3% of polyps

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3. Regarding peptic ulcerationa. H. pylori is a gram-positive bacillus

b. Duodenal is more common than gastric ulceration

c. Zollinger-Ellison syndrome is associated with gastrin hyposecretion

d. H2-blockers will heal 85-95% of duodenal ulcers in 8 weeks

e. Triple therapy can eradicate H. pylori in 80% of patients in one week

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4. Head Injuriesa. 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

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5. During surgery on the submandibular glanda. An incision on the lower border of the mandible is safe

b. The submandibular gland is seen to wrap around the posterior border of mylohyoid

c. The facial artery and vein are divided as they course through the deep part of the gland

d. The hypoglossal nerve is seen to loop under the submandibular duct

e. Damage to the lingual nerve will cause loss of sensation to the posterior third of the tongue

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6. Regarding pancreatic carcinomaa. 90% are ductal adenocarcinomas

b. Less than 20% occur in the head of the gland

c. The usual presentation is with pain, weight loss and obstructive jaundice

d. Ultrasound has a sensitivity of 80-90% in the detection of the tumour

e. Less than 20% of patients are suitable for curative surgery

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7. Regarding the management of major traumaa. Deaths follow a trimodal distribution

b. X-rays after the primary survey should be of AP Cervical spine, chest and pelvis

c. Cardiac tamponade is characterised by raised BP, low JVP and muffled heart sounds

d. Assessment of uncomplicated limb fractures should occur during the primary survey

e. Deterioration of the casualty during the primary survey should lead to the secondary survey

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8. Regarding appendicitisa. 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

e. Appendicitis is a possible diagnosis in the absence of abdominal tenderness

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9. Regarding stones in the gallbladdera. Cholesterol stones are the most common

b. Pigment stones are due increased excretion of polymerised conjugated bilirubin

c. Are not a risk factor for the development of gallbladder carcinoma

d. 90% of gallstones are radio-opaque

e. A mucocele of the gallbladder is caused by a stone impacted in Hartmann's pouch

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10. Stones in the common bile ducta. Are found in 30% of patients undergoing cholecystectomy (Without pre-op ERCP)

b. Can present with Charcot's Triad

c. Are suggested by an bile duct diameter >8mm on ultrasound

d. ERCP, sphincterotomy and balloon clearance is now the treatment of choice

e. If removed by exploration of the common bile duct the T-tube can be removed after 3 days

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Questions 11-20

11. Regarding crystalloid solutionsa. 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

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12. Regarding colloid solutionsa. Human albumin has a molecular weight of 69 kDa

b. Albumin has a half life in the circulation of about 15 hours

c. Gelatins (e.g. Haemaccel) are polysaccharides with a MW of about 35 kDa

d. Dextrans reduce platelet aggregation and can induce anaphylaxis

e. 6% Hydroxylethyl Starch (HES) is synthetic polysaccharide derived from amylopectin

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13. Central parenteral nutritiona. Is a hypo-osmolar solution

b. Typically contains 14-16g nitrogen as D-amino acids

c. Typically contains about 250g glucose

d. Is associated with metabolic disturbances in about 5% patients

e. Can induce derangement of liver function tests

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14. Solitary thyroid nodulesa. Are more prevalent in women

b. In the adult population less than 10% are malignant

c. More than 50% of scintigraphically cold nodules are malignant

d. The risk of a hot module being malignant is negligible

e. Should be surgically removed in all patients

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15. Regarding abdominal wall herniasa. Almost 100,000 hernia operations are performed annually in the United Kingdom

b. 20% of inguinal hernias are indirect

c. In women inguinal hernias are as common as femoral hernias

d. The mortality assocaited with strangulation is over 10%

e. The mortality has reduced dramatically over the past 30 years

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16. The femoral canala. Lies lateral to the femoral vein

b. Has the inguinal ligament as its anterior border

c. Has the lacunar ligament as its lateral border

d. Has the pectineal ligament as its posterior border

e. Contains the lymph node of Cloquet

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17. Intermittent claudicationa. Affects less than 1% of men over the age of 50 years

b. At 5 years 10% of claudicants will have progressed to an amputation

c. At 5 years 20% of claudicants will have died from ischaemic heart disease

d. Is usually associated with an ankle / brachial pressure index (ABPI) > 0.7

e. Is associated with a fall in the ABPI on exercise with delayed recovery

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18. The pathology of ulcerative colitisa. Shows full thickness inflammation

b. The rectum is almost always involved

c. 10% patients have terminal ileal disease

d. Enterocutaneous or intestinal fistulae are common

e. The serosa is usually normal

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19. Regarding surgery for ulcerative colitisa. 30% patients with total colitis will require surgery within 5 years

b. Panproctocolectomy and pouch formation is appropriate as an emergency operation

c. Pouches can be fashioned as 'S' 'J' or 'W' loops

d. Over 90% patients with a pouch have perfect continence

e. With a pouch the mean stool frequency is about 6 times per day

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20. Regarding benign breast diseasea. Cyclical mastalgia is the commonest reason for referral to the breast clinic

b. Fibroadenomas are derived from the breast lobule

c. Lactational breast abscesses are usually due to Staph aureusd. Duct ectasia is more common in smokers

e. Atypical lobular hyperplasia is associated with an increased risk of breast cancer

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Questions 21-30

21. Regarding anal fissuresa. 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

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22. Tamoxifen in the treatment of breast cancera. 20 mg per day is as effective as higher doses

b. Treatment for longer than 5 years has been proven to be beneficial

c. Is only of benefit in patients with oestrogen receptor positive tumours

d. Reduces the risk of contralateral breast cancer by 40%

e. Is effective in both pre and post menopausal women

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23. Fibroadenomasa. 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

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24. Familial adenomatous polyposisa. Is inherited as an autosomal recessive condition

b. Is characterised by polyp formation in late adulthood

c. Is associated with osteomas and epidermoid cysts in Gardener's Syndrome

d. Is due to a mutation on the short arm of chromosome 12

e. Can be screened for by rigid or flexible sigmoidoscopy

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25. Warfarina. 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

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26. Heparina. 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

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27. Regarding rectal cancera. It often arises in metaplastic polyps

b. The rectum is the commonest site of colorectal tumours

c. A cancer in the upper 1/3 of the rectum is appropriately managed by AP resection

d. Local recurrence of rectal cancer can be reduced a Total Mesorectal Excision

e. Chemotherapy is of proven benefit in Duke's A tumours

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28. The following cause hypercalcaemiaa. Sarcoidosis

b. Primary hyperparathyroidism

c. Acute pancreatitis

d. Metastatic bronchial carcinoma

e. Milk-Alkali syndrome

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29. Regarding malignant melanomaa. The incidence is halving every 10 years

b. Superficial spreading melanoma is the commonest clinico-pathological type

c. Tumour thickness is the most important prognostic indicator

d. Regional lymphadenectomy provides survival benefit in patients with 'thick' tumours

e. Acral lentiginous tumours are usually found on the trunk and proximal limbs

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30. Regarding oesophageal cancera. Squamous carcinomas predominate in the upper 2/3 of the oesophagus

b. Overall 5 year survival is greater than 50%

c. Tylosis genetically predisposes to the disease

d. 15% of adenocarcinomas are associated with Barrett's oesophagus

e. For palliation an Atkinson tube can be inserted endoscopically

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Questions 31-40

31. Infantile hypertrophic pyloric stenosisa. Occurs with a male : female ratio of 4:1.

b. Sons of affected mothers have a 20% risk of developing the lesion

c. Invariably presents between six and eights months of age

d. Typically presents with bile stained projectile vomiting

e. Surgical treatment is by Heller's Cardiomyotomy

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32. Oesophageal atresiaa. Is often associated with a distal trachea-oesophageal fistula

b. Polyhydramnios is often present late in pregnancy

c. 50% have other associated congenital abnormalities

d. Contrast X-ray studies are necessary to confirm the diagnosis

e. Post-operatively over 30% develop oesophageal strictures

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33. The following are features of Fallot's Tetralogya. An atrial septal defect

b. Pulmonary stenosis

c. Right ventricular hypertrophy

d. A left to right cardiac shunt

e. Cyanotic attacks during feeding and crying

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34. Phaeochromocytomasa. 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

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35. Regarding Cushing's Syndromea. 80% of cases are due to pituitary adenomas (Cushing's Disease)

b. Most ACTH secreting pituitary adenomas are more than 2 cm in diameter

c. Is characterised by loss of the diurnal rhythm of cortisol secretion

d. Cortisol production is suppressed by low-dose dexamethasone

e. Adrenal carcinomas are more common than adrenal adenomas

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36. The following are complications of parenteral nutritiona. Hyperglycaemia

b. Hypoglycaemia

c. Hypokalaemia

d. Hyperkalaemia

e. Hypercalcaemia

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37. The functions of a tracheostomy are toa. Bypass an upper airway obstruction

b. Increase the anatomical dead space

c. Increase airway resistance

d. Protect against aspiration

e. Allow frequent airway suction

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38. Regarding Hydatid diseasea. Is due to Entamoeba histolyticab. Man is an accidental intermediate host

c. The liver is the commonest site of infection

d. Can be diagnosed by the Casoni test

e. Is resistant to treatment by metronidazole

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39. Medullary carcinoma of the thyroida. Is a tumour of the parafollicular C cells

b. Produce thyroxine as the principle hormone

c. 10% of cases are sporadic

d. Can occur as part of the MEN type II syndrome

e. Total thyroidectomy is the surgical treatment of choice

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40. The following are features of thyrotoxicosisa. Weight gain

b. Palpitations

c. Proximal myopathy

d. Increased skin pigmentation

e. Pretibial myxoedema

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Questions 41-50

41. Regarding local anaesthesiaa. 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

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42. With an iron deficiency anaemiaa. Both serum iron and total iron binding capacity are reduced

b. The blood film shows a hyperchromic microcytic picture

c. The reticulocyte count is low in relation to the degree of anaemia

d. Serum ferritin levels are increased

e. The platelet count may be increased

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43. Regarding abdominal aortic aneurysmsa. They commonly remain symptomless until they rupture

b. The risk of rupture increases with aortic diameter

c. Elective repair should have a 30-day mortality of less than 5%

d. Emergency repair has a 30-day mortality of less than 10%

e. The benefits of surgery for small (4.0-5.5 cm) is proven

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44. Regarding hepatitis Ba. It is due to an RNA virus

b. It has an incubation period of 2 to 6 days

c. It can be transmitted via blood products

d. About 1% of the UK population are Hepatitis B Surface Antigen positive

e. About 10% of infected patients become chronic carriers

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45. Regarding vascular graftsa. PTFE grafts are less porous than Dacron

b. Vein grafts have better long-term patency

c. Graft failure less than a month after surgery is usually due to a surgical error

d. Graft failure within the first year is often due to neo-intimal hyperplasia

e. Graft failure beyond one year is due to progression of the underlying disease

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46. Regarding colorectal carcinomasa. About 40% present as surgical emergencies

b. Right-sided tumours often present with a change in bowel habit

c. 75% of tumours can be reached with a flexible sigmoidoscope

d. Over 20% of patients present with more than one primary tumour

e. A Duke's B tumour has nodal metastases

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47. Regarding colonic polypsa. Metaplastic polyps are pre-malignant

b. Adenomatous polyps are pre-malignant

c. Villous adenomas are more common than tubular adenomas

d. Genetic mutations can result in epithelial metaplasia

e. Most carcinomas arise in adenomatous polyps

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48. In patients with carotid artery diseasea. A bruit is a reliable sign of the degree of stenosis

b. Atheroma is most commonly seen in the external carotid artery

c. An embolic event often results in an ipsilateral hemiplegia

d. Prophylactic aspirin reduces the risk of a stroke

e. Surgery is of proven benefit in those with asymptomatic stenoses

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49. Regarding acute limb ischaemiaa. Arterial occlusion has less dramatic effects in those with underling occlusive disease

b. Occurs more often in patients in sinus rhythm

c. Objective sensory loss requires urgent treatment

d. Fixed skin staining is an early sign

e. Intra-arterial thrombolysis is invariably successful with no morbidity

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50. Regarding muscle relaxantsa. Suxamethonium is a non-depolarising agent

b. Vecuronium is a depolarising agent

c. Suxamethonium induces histamine release and can produce a 'scoline rash'

d. Suxamethonium has a duration of action of about 5 minutes in most people

e. Scoline apnoea is due to pseudocholinesterase deficiency

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Questions 51-60

51. Regarding the use of laxativesa. 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

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52. Hepatocellular carcinomaa. Has a high incidence in East Africa and South-east Asia

b. Its worldwide incidence parallels the prevalence of Hepatitis B

c. Mycotoxins (e.g. aflatoxin) are an important aetiological factor

d. Over 80% of tumours are surgically resectable

e. Liver transplantation offers the only chance of cure in those with irresectable disease

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53. Serum alpha fetoproteina. Is increased in testicular tumours

b. In testicular tumours is produced by trophoblastic elements

c. Is increased in over 70% patients with hepatocellular carcinoma

d. In patients with hepatocellular carcinoma levels correlate well with size of the tumour

e. In patients with hepatocellular carcinoma levels rise following resection of the tumour

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54. Regarding testicular tumoursa. They are the commonest malignancy in young men

b. Peak incidence for teratomas is seen at the age of 50 years

c. Seminomas are radiosensitive

d. Over 75% of Stage I teratomas are cured by surgery alone

e. Chemotherapy rarely produces a cure in those with metastatic disease

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55. In patients with ascitesa. A transudate has a protein content of greater than 30 g per litre

b. Both malignancy and infection result in a transudate

c. Ovarian carcinoma is the commonest malignant cause of ascites

d. Cirrhosis results in marked sodium retention

e. Tumour cells increase the permeability of the peritoneum

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56. Duct ectasiaa. If often associated with both aerobic and anaerobic bacterial infection

b. The incidence is reduced in smokers

c. May present with a green or watery nipple discharge

d. May present with nipple inversion

e. Can be adequately treated with a microdochectomy

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57. Regarding opiate analgesiaa. Patient controlled analgesia (PCA) is more effective than intermittent parenteral dosing

b. The total opiate dose is usually reduced with a PCA

c. Fentanyl is more water soluble than morphine

d. Epidural morphine can result in late respiratory depression

e. Epidural and parenteral morphine can be safely administered together

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58. Regarding renal failurea. Ureteric obstruction produces pre-renal renal failure

b. Pre-renal renal failure produces a high urinary sodium (>20 mmol/l)

c. Pre-renal renal failure produces a high urine osmolality (>500 mosm/kg)

d. Non-steroidal anti-inflammatory drugs increase glomerular blood flow

e. Patients with an increased creatinine are at increased risk of postoperative renal failure

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59. Regarding colonic polypsa. Juvenile polyps are usually pre-malignant

b. Metaplastic polyps often exceed 2 cm in diameter

c. Metaplastic polyps are pre-malignant

d. Villous adenomas are more prone to malignant transformation than tubular adenomas

e. Approximately 10% of the population older than 45 years have asymptomatic polyps

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60. Intussusceptiona. 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

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Questions 61-70

61. Hirschsprung's diseasea. 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

e. On rectal biopsy there increased acetylcholinesterase containing cells in the muscularis

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62. Renal cell carcinomaa. Arises from the distal convoluted tubule of the kidney

b. Presents with haematuria, loin pain and a mass in 10% of patients

c. Can present with polycythaemia

d. Spread occurs into renal vein and inferior vena cava in 10% patients

e. Should be treated with a nephrouretectomy

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63. Laparoscopic cholecystectomya. Is usually performed using a four port technique

b. The Veress needle is an 'open' technique for inducing the pneumoperitoneum

c. A supraumbilical abdominal scar is a contraindication to laparoscopic cholecystectomy

d. Dissection of Calot's triangle should be performed before the cystic duct is clipped

e. Most series report a conversion rate of over 20%

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64. Regarding cardiovascular disease in the surgical patienta. Following a myocardial infarct elective surgery should be deferred for over 6 months

b. 60% of post-operative re-infarctions are clinically silent

c. The mortality of a post-operative myocardial infarct is about 40%

d. The risk of a post-operative infarct is reduced in hypertensive patients

e. Left ventricular ejection fraction is a useful marker of cardiovascular function

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65. The following cause a microcytic anaemiaa. B12 deficiency

b. Folate deficiency

c. Thalassaemia minor

d. Hypothyroidism

e. Iron deficiency

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66. In obstructive jaundicea. Urinary conjugated bilirubin is increased

b. Serum unconjugated bilirubin is increased

c. Urinary urobilinogen is reduced

d. Serum conjugated bilirubin is reduced

e. Faecal stercobilinogen is reduced

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67. The following are clinical features of a large pulmonary embolisma. Pleuritic chest pain

b. Haemoptysis

c. High fever

d. Bradycardia

e. Collapsed neck veins

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68. In patients with a proven pulmonary embolusa. Only 10% have clinical evidence of deep venous thrombosis

b. The classic ECG features are described S1Q3T3

c. Arterial blood gases are normal in 50% of patients

d. Low molecular weight heparins are as effective a heparin infusion

e. Thrombolysis should be considered if evidence of haemodynamic instability

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69. Regarding the anatomy of the inguinal canala. 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

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70. The thyroid glanda. Arises from the pharyngeal floor between the 1st and 2nd pharyngeal pouches

b. The isthmus lies at the level of the thyroid cartilage

c. The superior thyroid artery lies close to the external laryngeal nerve

d. The inferior thyroid artery arises from the costo-cervical trunk

e. The middle thyroid vein joins the external jugular artery

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Questions 71-80

71. Coeliac diseasea. 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

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72. Papillary carcinoma of the thyroida. Can be reliably diagnosed using fine needle aspiration cytology

b. Is almost always unifocal

c. Histologically displays Psammoma bodies

d. Typically spread to the cervical lymph nodes

e. Requires a total thyroidectomy for large tumours

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73. Regarding bladder tumoursa. 90% are squamous carcinomas

b. Painless haematuria is the commonest presentation

c. Cigarette smoking is an important aetiological factor

d. 80% of tumours are superficial (i.e. no muscle invasion)

e. Superficial tumours are often well controlled by transurethral resection

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74. The following are carcinogens important in bladder cancera. Magenta

b. Auramine

c. Benzidine

d. Beta-naphthylamine

e. Chlorinated hydrocarbons

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75. Regarding ureteric calculia. Are most often composed of calcium oxalate or phosphate

b. Less than 5% of those less than 5 mm in diameter pass spontaneously

c. Extracorporeal lithotripsy is useful for stones in the upper third of the ureter

d. About 30% of patients require open surgery to remove the stone

e. An obstructed ureter in the presence of infection is a surgical emergency

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76. Cryptorchidisma. 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

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77. Regarding small bowel obstructiona. In the United Kingdom is most often due to an obstructed hernia

b. Causes colicky abdominal pain and vomiting

c. Abdominal distension is seen in all patients

d. All cases can be managed conservatively for the first 24 hours

e. Rarely requires aggressive fluid resuscitation

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78. Regarding bone scintigraphya. It is less sensitive than radiographs in detecting metastatic bone disease

b. It is performed using technetium labeled biphosphonates

c. The radiation dose received is equivalent to a CT scan

d. Renal excretion of the isotope can cause false positive images

e. Has a high risk of anaphylaxis

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79. Regarding nephroblastomasa. They are otherwise known as a Wilm's tumour

b. Account for 10% of childhood tumours

c. The commonest presentation is with an abdominal mass

d. Most commonly present in adolescence

e. They are composed purely of epithelial elements

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80. Regarding bladder calculia. The incidence has fallen markedly in this country since the late 19th century

b. They may be totally asymptomatic

c. They are more prevalent in patients with chronic urinary sepsis

d. They are associated with squamous metaplasia of the bladder mucosa

e. They increase the risk of transitional cell carcinoma

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Questions 81-90

81. Regarding gas gangrenea. 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

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82. Hodgkin's diseasea. Most commonly occurs in patients over 60 years of age

b. Usually presents as painless lymphadenopathy

c. The Pel-Epstein fever is a characteristic feature

d. Stage III disease is confined to one side of the diaphragm

e. Reed-Sternberg cells are a diagnostic feature

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83. Regarding varicose veinsa. They affect over 20% of the population

b. Over 20% are recurrent varicosities

c. The sural nerve is in danger during stripping of the long saphenous vein

d. The saphenous nerve is closely associated with the short saphenous vein

e. 5% oily phenol is an appropriate sclerosant for venous sclerotherapy

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84. The following are clinical features of Horner's syndromea. Miosis

b. Failure of abduction of the orbit

c. Ptosis

d. Increased sweating on the contralateral side of the forehead

e. Exophthalmos

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85. Side effects of suxamethonium includea. A rash

b. A profound tachycardia

c. Muscle pain

d. Malignant hypopyrexia

e. Prolonged neuromuscular blockade

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86. Conn's syndromea. Is due to secondary hyperaldosteronism

b. Can result in hypokalaemia

c. Can result in a metabolic alkalosis

d. Is most often due to an adrenal adenoma

e. Can cause severe hypotension

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87. Haemorrhage of over one litre will producea. A reduction in renal blood flow

b. An increase in platelet count

c. A fall in arterial pH

d. Increased fibrinolysis

e. A fall in body temperature

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88. A prolonged prothrombin time is found in the following conditionsa. Liver failure

b. Adrenal failure

c. Pre-hepatic jaundice

d. Factor VII deficiency

e. Malabsorption with steatorrhoea

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89. The radial nervea. Is a branch of the posterior cord of the brachial plexus

b. Is derived from the posterior primary rami of C5 to C7

c. Supplies the extensors of the arm

d. Gives rise to the anterior interosseous nerve

e. Injury produces a classical wrist drop

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90. Amyloidosisa. 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

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Questions 91-100

91. Ectopic pregnancya. 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

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92. Pelvic inflammatory diseasea. Usually arises from haematogenous spread from another site

b. Is most commonly a chlamydial infection

c. Untreated can progress to a pyosalpinx

d. Reduces the risk of ectopic pregnancy

e. 20% of patients develop chronic pain

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93.The following colonic polyps are pre-malignanta.Juvenile polyps

b.Hamartomatous polyps associated with Peutz-Jeghers syndrome

c.Villous adenomas

d.Tubular adenomas

e.Metaplastic polyps

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94.Tetanusa.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

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95.Multiple myelomaa.Results from a polyclonal proliferation of lymph node plasma cells

b.Often presents with back pain or pathological fractures

c.Hypercalcaemia develops in 50% of patients

d.X-rays are normal in most patients

e.Most patients have a serum paraproteinaemia

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96.Regarding pathological termsa.Hypertrophy is an increase in tissue size due to increased cell number

b.Hyperplasia is an increase in tissue size due to an increase in cell size

c.Atrophy is an increase in tissue size to disuse

d.Metaplasia is a change form one abnormal tissue type to another

e.A hamartoma is a developmental abnormality

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97.Osteoporosis is associated witha.Vitamin D deficiency

b.Vitamin A deficiency

c.Chronic renal failure

d.Prolonged bed rest

e.Hyperparathyroidism

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98.The haemoglobin-oxygen dissociation curve is shifted to the left bya.Increased body temperature

b.Metabolic acidosis

c.Chronic hypoxia

d.Anaemia

e.Erythropoietin

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99. Metastatic calcification is seen ina.Hyperparathyroidism

b.Sarcoidosis

c.Fat necrosis

d.Atheroma

e.Tuberculosis

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100.Intrinsic factora.Is a polysaccharide

b.Is produced by the parietal cells in the stomach

c.Acts in the terminal ileum

d.Is important in the absorption of folic acid

e.Deficiency can be treated with oral B12

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