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Questions 61-70

61. Hirschsprung's disease

a. 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

62. Renal cell carcinoma

a. 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

63. Laparoscopic cholecystectomy

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 over 20%

64. Regarding cardiovascular disease in the surgical patient

a. 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

65. The following cause a microcytic anaemia

a. B12 deficiency

b. Folate deficiency

c. Thalassaemia minor

d. Hypothyroidism

e. Iron deficiency

66. In obstructive jaundice

a. 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

67. The following are clinical features of a large pulmonary embolism

a. Pleuritic chest pain

b. Haemoptysis

c. High fever

d. Bradycardia

e. Collapsed neck veins

68. In patients with a proven pulmonary embolus

a. 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

69. Regarding the anatomy of the inguinal canal

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 lateral part of the posterior wall

70. The thyroid gland

a. 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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