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



KEY
1. True= A, D, E
2. True= B, C, E
3. True= B, D, E
4. True= A, D, E
5. True= B
6. True= A,C,D,E
7. True= A
8. True= All true
9. True= A, E
10. True= A, B, C, D