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Questions 1-10

1. The following are absorbable sutures

a. Catgut

b. Silk

c. Polyamide (Nylon)

d. Polyglyconate (Maxon)

e. Polyglactin (Vicryl)

2. Peutz Jeghers Syndrome

a. 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

3. Regarding peptic ulceration

a. 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

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

5. During surgery on the submandibular gland

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

6. Regarding pancreatic carcinoma

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

7. Regarding the management of major trauma

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

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

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

9. Regarding stones in the gallbladder

a. 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

10. Stones in the common bile duct

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

 
 

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