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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

52. Hepatocellular carcinoma

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

53. Serum alpha fetoprotein

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 rise following resection of the tumour

54. Regarding testicular tumours

a. 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

55. In patients with ascites

a. 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

56. Duct ectasia

a. 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

57. Regarding opiate analgesia

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 water soluble than morphine

d. Epidural morphine can result in late respiratory depression

e. Epidural and parenteral morphine can be safely administered together

58. Regarding renal failure

a. 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

59. Regarding colonic polyps

a. 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

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



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