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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

22. Tamoxifen in the treatment of breast cancer

a. 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

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

24. Familial adenomatous polyposis

a. 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

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

27. Regarding rectal cancer

a. 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

28. The following cause hypercalcaemia

a. Sarcoidosis

b. Primary hyperparathyroidism

c. Acute pancreatitis

d. Metastatic bronchial carcinoma

e. Milk-Alkali syndrome

29. Regarding malignant melanoma

a. 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

30. Regarding oesophageal cancer

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


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