The following are absorbable sutures .

a. Catgut
b. Silk
c. Polyamide (Nylon)

d. Polyglyconate (Maxon)
e. Polyglactin (Vicryl)

During surgery on the submandibular gland .2

a. 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

Regarding pancreatic carcinoma false .3

a. 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

Regarding the management of major trauma .4

a. 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

Regarding appendicitis .5
a. The risk of developing the illness is greatest in childhood
. b. Mortality decreases with age
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

Regarding stones in the gallbladder .6

a. Cholesterol stones are the least 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

Stones in the common bile duct the false is .7

a. 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

Regarding crystalloid solutions the false is .8

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

Solitary thyroid nodules the false is .9

a. Are more prevalent in women
b. In the adult population less than 10% are malignant
c. Less than 20% 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

Regarding abdominal wall hernias the false is .10

a. Almost 100,000 hernia operations are performed annually in the United Kingdom
b. Over 60% 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

The femoral canal the false is .11

a. Lies medial 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

Intermittent claudication the false is .12

a. 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) 0.3- 0.7
e. Is associated with a fall in the ABPI on exercise with delayed recovery

The pathology of ulcerative colitis the false is .13

a. Shows full thickness inflammation

b. The rectum is almost always involved

c. 10% patients have terminal ileal disease
d. Enterocutaneous or intestinal fistulae are less common
e. The serosa is usually normal

Regarding benign breast disease the false is .14

a. 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 aureus

d. Duct ectasia is less common in smokers

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

Regarding anal fissures the false is .15

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
Fibroadenomas the false is .16

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

Warfarin the false is .17

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

Heparin the false is .18

a. Is a heterogeneous mixture of sulphated polysaccharides
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

The following cause hypercalcaemia except .19

a. Sarcoidosis
b. Primary hyperparathyroidism

c. Acute pancreatitis
d. Metastatic bronchial carcinoma
e. Milk-Alkali syndrome

Regarding oesophageal cancer the false is .20

a. 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

Infantile hypertrophic pyloric stenosis

the false is .21

.a. 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 three and four weeks of age
d. Typically presents with nonbilious vomiting

e. Surgical treatment is by Heller's Cardiomyotomy

Oesophageal atresia

the false is .22

a. 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

The following are features of Fallot's Tetralogy

a. An atrial septal defect

b. Pulmonary stenosis

except .23

c. Right ventricular hypertrophy

d. A right to left cardiac shunt
e. Cyanotic attacks during feeding and crying

The functions of a tracheostomy are to

except .24

a. Bypass an upper airway obstruction

b. Reduce the anatomical dead space

c. Increase airway resistance

d. Protect against aspiration
e. Allow frequent airway suction

Medullary carcinoma of the thyroid

the false is .25

a. Is a tumour of the parafollicular C cells

b. Produce thyroxine as the principle hormone

c. 90% of cases are sporadic
d. Can occur as part of the MEN type II syndrome
e. Total thyroidectomy is the surgical treatment of choice

The following are features of thyrotoxicosis

a. Weight gain
b. Palpitations
c. Proximal myopathy
d. Increased skin pigmentation

except .26

e. Pretibial myxoedema

Regarding abdominal aortic aneurysms the false is .27

a. 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 unproven

In patients with carotid artery disease .28

a. 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

Hepatocellular carcinoma the false is .29

a. 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

Serum alpha fetoprotein the false is .30

a. 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 fall following resection of the
tumour

Regarding testicular tumours .31

a. They are the commonest malignancy in young men
b. Peak incidence for teratomas is seen at the age of 25 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

In patients with ascites the false is .32

a. A exudate 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

Regarding opiate analgesia the false is .33

a. 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 lipid soluble than morphine
d. Epidural morphine can result in late respiratory depression

e. Epidural and parenteral morphine can be safely administered together

Intussusception the false is .34

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

Hirschsprung's disease the false is .35

a. Is due to absent ganglion cells in Auerbach's plexus

b. 10% cases have involvement of the recto-sigmoid segment

c. 80% cases present with delayed passage of meconium in the first 24 hours after
birth

d. The affected segment of bowel appears as cone-shaped contracted zone on barium

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

Laparoscopic cholecystectomy the false is .36

a. 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 less than 5%

In obstructive jaundice the false is .37

a. Urinary conjugated bilirubin is increased

b. Serum unconjugated bilirubin is increased

c. Urinary urobilinogen is reduced
d. Serum conjugated bilirubin is increased
e. Faecal stercobilinogen is reduced

Regarding the anatomy of the inguinal canal the false is .38

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 medial part of the posterior wall

Papillary carcinoma of the thyroid the false is .39

a. 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

Regarding bladder tumours the false is .40

a. 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
Regarding ureteric calculi the false is .41
a. Are most often composed of calcium oxalate or phosphate
b. Most stones 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

Regarding bladder calculi the false is .42

a. 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

Ectopic pregnancy the

false is .43

a. Occurs in about 1% 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 positive pregnancy test
e. if shocked early laparotomy is essential

Tetanus

the false is .44

a. Is due to an infection with a gram-positive 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

Regarding pathological terms .45

a. 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