SBAs and EMIs for the General Surgery

FRCS Richard Molloy

Visit to download the full and correct content document:
https://textbookfull.com/product/sbas-and-emis-for-the-general-surgery-frcs-richard-m
olloy/
More products digital (pdf, epub, mobi) instant
download maybe you interests ...

FRCS General Surgery A Road to Success 1st Edition Mr

Pradip K Datta

https://textbookfull.com/product/frcs-general-surgery-a-road-to-
success-1st-edition-mr-pradip-k-datta/

SBAs for the FRCS Tr Orth Examination A Companion to

Postgraduate Orthopaedics Candidate s Guide Paul A.
Banaszkiewicz

https://textbookfull.com/product/sbas-for-the-frcs-tr-orth-
examination-a-companion-to-postgraduate-orthopaedics-candidate-s-
guide-paul-a-banaszkiewicz/

Fundamentals of General Surgery Francesco Palazzo

https://textbookfull.com/product/fundamentals-of-general-surgery-
francesco-palazzo/

General Surgery Examination and Board Review Robert B.

Lim

https://textbookfull.com/product/general-surgery-examination-and-
board-review-robert-b-lim/
MCQs for the FRCS(Urol) and Postgraduate Urology
Examinations Manit Arya

https://textbookfull.com/product/mcqs-for-the-frcsurol-and-
postgraduate-urology-examinations-manit-arya/

Trauma for the FRCS (Tr Orth) Examination 1st Edition

Elliott

https://textbookfull.com/product/trauma-for-the-frcs-tr-orth-
examination-1st-edition-elliott/

Acute Care General Surgery Workup and Management 1st

Edition Dale A. Dangleben

https://textbookfull.com/product/acute-care-general-surgery-
workup-and-management-1st-edition-dale-a-dangleben/

Trauma Vivas for the FRCS : a Case-Based Approach First

Edition Anakwe

https://textbookfull.com/product/trauma-vivas-for-the-frcs-a-
case-based-approach-first-edition-anakwe/

SBAs for the Final FRCA 1st Edition Caroline Whymark

Ross Junkin Judith Ramsey

https://textbookfull.com/product/sbas-for-the-final-frca-1st-
edition-caroline-whymark-ross-junkin-judith-ramsey/
SBAs and EMIs for the
General Surgery FRCS
SBAs and EMIs for the
General Surgery FRCS

Edited by
Richard G. Molloy
Consultant Colorectal Surgeon
Queen Elizabeth University Hospital, Glasgow UK

Graham J. MacKay
Consultant Colorectal Surgeon and Honorary Associate Professor,
Glasgow Royal Infirmary, UK

Campbell S. Roxburgh
Clinical Senior Lecturer and Honorary Consultant Colorectal Surgeon,
Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences,
University of Glasgow, UK

Martha M. Quinn
Consultant in Surgical Oncology
Glasgow Royal Infirmary, UK

1
3
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Oxford University Press 208
The moral rights of the authors have been asserted
First Edition published in 208
Impression: 
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by licence or under terms agreed with the appropriate reprographics
rights organization. Enquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above
You must not circulate this work in any other form
and you must impose this same condition on any acquirer
Published in the United States of America by Oxford University Press
98 Madison Avenue, New York, NY 006, United States of America
British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number: 208937423​
ISBN 978–​0–​9–​87945–​8
Printed and bound by
CPI Group (UK) Ltd, Croydon, CR0 4YY
Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
the product information and clinical procedures with the most up-​to-​date
published product information and data sheets provided by the manufacturers
and the most recent codes of conduct and safety regulations. The authors and
the publishers do not accept responsibility or legal liability for any errors in the
text or for the misuse or misapplication of material in this work. Except where
otherwise stated, drug dosages and recommendations are for the non-​pregnant
adult who is not breast-​feeding
Links to third party websites are provided by Oxford in good faith and
for information only. Oxford disclaims any responsibility for the materials
contained in any third party website referenced in this work.
 PREFACE

Our aim with SBAs and EMIs for the General Surgery FRCS is to provide high-​quality sample
questions for trainees in General Surgery preparing to sit the FRCS Section  examination. The
Intercollegiate FRCS examination in General Surgery is the exit exam, which must be passed to
qualify for the award of a Certificate of Completion of Training (CCT) by the General Medical
Council Postgraduate Board. Candidates for the exam must hold a medical qualification recognized
for registration by the General Medical Council of the United Kingdom or the Medical Council of
Ireland and must be qualified for at least six years. They must also have evidence that they have
reached the clinical competencies required for the award of a CCT.
The FRCS examination is divided in two sections. The Section  examination is a written test
composed of Single Best Answer (multiple choice questions, choose one from five options) and
Extended Matching Item questions (EMI). The examination is divided into two papers designed to
cover the content of the curriculum as defined in the Intercollegiate Surgical Curriculum (<http://​
www.iscp.ac.uk>). Paper  consists of 0 SBA questions over 2 hours and Paper 2 consists of 35
EMI questions over 2 hours and 30 minutes. Successful completion of the Section  examination
is required before being allowed to proceed to Section 2. The Section 2 examination consists of a
series of structured clinical and oral interviews covering general surgery, emergency surgery, trauma
and critical care, and specialty topics. Further information regarding the examination can be found
on the website of the Joint Committee on Intercollegiate Examinations (<http://​www.jcie.org.
uk>).
This book contains sample questions laid out by sub-​specialty and in the same format that
candidates will be presented with in the Section  examination. The questions are mapped to
specific areas of the surgical curriculum and mirror the level required for the successful award
of an FRCS. Each question is accompanied by a detailed explanation of the answer and, where
appropriate, signposts the reader to further resources. These features mean that the book not only
helps you to assess your level of knowledge and practice completing MCQs but also adds depth to
the learning experience and directs ongoing revision.
Many of the contributors to the book have successfully passed the FRCS in General Surgery within
the last two to three years and so have an intimate knowledge of the examination in its current
form. As an editorial group our aim has been to provide an accurate, high-​quality, comprehensive
resource of sample questions in an easily accessible format. We hope that you find the text useful in
your preparations and wish you every success with both the examination and your further surgical
career.
 ACKNOWLEDGEMENTS

To Brigid, Niamh, and Jessica. As always, I couldn’t do what I do without all your love and support.
Richard
To Catherine, Emily, Finlay, and Murdo. For your love and patience and for still being there when the
computer is switched off.
Graham
To Tricia, Hamish, Annie, and Fraser. Thank you for all your help and support.
Campbell
To Stuart, Fraser, and Arran. Thank you for all your support, especially during my time away.
Martha
 CONTENTS

Abbreviations xi
Contributors xxi

 Basic science
Questions 1
Answers 16

2 Perioperative and critical care

Questions 35
Answers 50

3 General surgery
Questions 69
Answers 87

4 Colorectal surgery
Questions 117
Answers 136

5 Hepatopancreaticobiliary surgery
Questions 173
Answers 187

6 Oesophagogastric surgery
Questions 227
Answers 243
x Contents

7 Breast surgery
Questions 269
Answers 280

8 Endocrine surgery
Questions 299
Answers 308

9 Transplant surgery
Questions 325
Answers 334

0 Vascular surgery
Questions 351
Answers 363

Index 38
 ABBREVIATIONS

5-​HIAA 5-​hydroxyindoleacetic acid

A&E Accident and Emergency
A–​aO2 alveolar–​arterial gradient
AAA abdominal aortic aneurysm
AAST American Association for the Surgery of Trauma
ABCDE Age, Blood pressure fall, Comorbidity, Diagnosis, and Evidence of bleeding
ABG arterial blood gas
ABMR antibody-​mediated rejection
ABPI ankle-​brachial pressure index
ACE angiotensin-​converting enzyme
ACOT acute coagulopathy of trauma
ACPGBI Association of Coloproctology of Great Britain and Ireland
ACPO acute colonic pseudo-​obstruction
ACS abdominal compartment syndrome
ACT Anal Cancer Trial
ACTH adrenocorticotropic hormone
ADH antidiuretic hormone
AEN acute oesophageal necrosis
AF atrial fibrillation
AFP alpha-​fetoprotein
AI aromatase inhibitor
AIDS acquired immunodeficiency syndrome
AIN anal intraepithelial neoplasia
AIP autoimmune pancreatitis
AKI acute kidney injury
ALS afferent loop syndrome
AMR antibody-​mediated rejection
ANA antinuclear antibody
ANC acute necrotic collection
AP acute pancreatitis
AP anteroposterior/​abdomino-​perineal
xii Abbreviations

APC adenomatous polyposis coli

APFC acute peri-​pancreatic fluid collections
APP abdominal perfusion pressure
APTT activated partial thromboplastin time
APUD amine precursor uptake and decarboxylation
ARDS adult respiratory distress syndrome
ARR absolute risk reduction
ASA American Society of Anesthesiologists
ATG anti-​thymocyte globulin
ATLS Advanced Trauma Life Support
ATP adenosine triphosphate
AXR abdominal X-​ray
AVF arteriovenous fistula
AVG arteriovenous grafts
BAETS British Association of Endocrine and Thyroid Surgeons
BMA bone-​modifying agents
BMI body mass index
BP blood pressure
bpm beats per minute
BI-​RADS Breast Imaging and Reporting Data System
BSG British Society of Gastroenterology
C&S Culture and sensitivity/​cerebrospinal
CABG coronary artery bypass graft
cAMP cyclic Adenosine Monophosphate
CBD common bile duct
CCK cholecystokinin
CD Crohn’s disease
CDC complement-​dependent cytotoxicity
CDI Clostridium difficile infection
CFTR cystic fibrosis transmembrane conductance regulator
CHRPE congenital hypertrophy of the retinal pigment epithelium
CIPO chronic intestinal pseudo-​obstruction
CKD chronic kidney disease
cm centimetre
CMV cytomegalovirus
CN cranial nerve
CONSORT CONsolidated Standards Of Reporting Trials
COPD chronic obstructive pulmonary disease
CPAP continuous positive airway pressure
 Abbreviations xiii

CRC colorectal cancer

CRF calculated reaction frequency
CRLM colorectal liver metastases
CRM circumferential resection margin
CRP C-​reactive protein
CR-​POSSUM colorectal POSSUM
CT computed tomography
CTT Certificate of Completion of Training
CVS critical view of safety
CXR chest X-​ray
DASH disability of the arm, shoulder, and hand
DASS dialysis-​associated steal syndrome
DBD donation after brain death
DCD donation after cardiac death
DCI distal contractile integral
DCIS ductal carcinoma in situ
DFSP dermatofibrosarcoma protuberens
DI diabetes insipidus
DIC disseminated intravascular coagulation
DIEP deep inferior epigastric artery perforator
DNA deoxyribonucleic acid
DNC death using neurological criteria
DOAC direct oral anticoagulant
DSA donor-​specific antibodies
DVT deep venous thrombosis
EBL endoscopic band ligation
EBV Epstein–​Barr virus
ECF epirubicin, cisplatin, and 5-​fluorouracil
ECG electrocardiogram
ECMO extracorporeal membrane oxygenation
EGFR epidermal growth factor receptor
EHEC enterohaemorrhagic E. coli
EIM extra-​intestinal manifestations
ELC early laparoscopic cholecystectomy
EIM extra-​intestinal manifestation
ELC early laparoscopic cholecystectomy
EMI extended matching item
EMR endoscopic mucosal resection
EPP extraperitoneal pelvic packing
xiv Abbreviations

ER oestrogen receptor
ERAS enhanced recovery after surgery
ERCP endoscopic retrograde cholangiopancreatography
ESD endoscopic submucosal dissection
ESR erythrocyte sedimentation rate
ESRD end-​stage renal disease
ETEC enterotoxigenic E. coli
ETT endotracheal tube
EUA examination under anaesthetic
EUS endoscopic ultrasound
FAP familial adenomatous polyposis
FAST Focused Assessment with Sonography for Trauma
FBC full blood count
FC flow cytometry
FDP fibrin/​fibrinogen degradation products
FDG fluorodeoxyglucose
FEC fluorouracil, epirubicin, cyclophosphamide
FES fat embolism syndrome
FEV forced expiratory volume in one second
FFP fresh frozen plasma
FGPD fundic gland polyp with low-​grade dysplasia
FMD fibromuscular dysplasia
FNA fine needle aspiration
FNAC fine needle aspiration cytology
FNH focal nodular hyperplasia
FOB faecal occult blood
FRC functional residual capacity
FRCS Fellow of the Royal College of Surgeons
FSH follicle-​stimulating hormone
FU fluorouracil
FVC forced vital capacity
GBS Glasgow–​Blatchford score
GCA giant cell arteritis
GCS Glasgow Coma Scale
GCSF granulocyte colony-​stimulating factor
GES gastric electrical stimulation
GFR glomerular filtration rate
GH growth hormone
GI gastrointestinal
 Abbreviations xv

GIST gastrointestinal stromal tumour

GMC General Medical Council
GORD gastro-​oesophageal reflux disease
GOV gastro-​oesophageal varices
GP General Practitioner
GPS Glasgow Prognostic Score
GTN glyceryl trinitrate
GSF glomerular filtration rate
H2RA H2 receptor antagonist
H&E haemotoxylin and eosin
HA hepatic adenoma
HAART highly active antiretroviral therapy
Hb haemoglobin
HBS hungry bone syndrome
HBsAG hepatitis B surface antigens
HBV hepatitis B virus
HCC hepatocellular carcinoma
HDGC hereditary diffuse gastric carcinoma syndrome
HDU high-​dependence unit
HER human epidermal growth factor receptor
HIPEC hyperthermic intra-​peritoneal chemotherapy
HIAA hydroxyindoleacetic acid
HIPEC hyperthermic intra-​peritoneal chemotherapy
HIT heparin-​induced thrombocytopenia
HIV human immunodeficiency virus
HLA human leucocyte antigen
HNPCC hereditary non-​polyposis colorectal cancer
HPB hepato-​pancreaticobiliary
HPN home parenteral nutrition
HPV human papilloma virus
hr hour
HSIL high-​grade squamous epithelial lesion
HTA Human Tissue Authority
HTK histidine–​tryptophan–​ketoglutarate
HUS haemolytic uraemic syndrome
HVPG hepatic venous pressure gradient
IA independent assessor
IAH intra-​abdominal hypertension
IAP intra-​abdominal pressure
xvi Abbreviations

IBD inflammatory bowel disease

ICA intracranial carotid artery
ICU Intensive Care Unit
IDCP idiopathic duct-​centric pancreatitis
IDDM insulin-​dependent diabetes mellitus
IGCLC International Gastric Cancer Linkage Consortium Criteria
IGV isolated gastric varices
IL Interleukin
IMA inferior mesenteric artery
IMPACT Improved Protection Against CMV in Transplant
IMPDH inhibitor of inosine monophosphate dehydrogenase
INR international normalized ratio
IOC intraoperative cholangiography
IPMN intraductal papillary mucinous neoplasm
ITP idiopathic thrombocytopenic purpura
IV intravenous
IVC inferior vena cava
LAMN low-​grade appendiceal mucinous neoplasms
LARS low anterior resection syndrome
LCIS lobular carcinoma in situ
LD latissimus dorsi
LFT liver function tests
LGV lymphogranuloma venereum
LH luteinizing hormone
LHM laparoscopic Heller’s myotomy
LICAP lateral intercostal artery perforator
LIS lateral internal sphincterotomy
LMWH low molecular weight Heparin
LOS lower oesophageal sphincter
LSIL low-​grade squamous intraepithelial lesion
LVEF left ventricular ejection fraction
LVI lymphovascular invasion
MALT mucosa-​associated lymphoid tissue
MAP mean arterial pressure
MAPK mitogen-​activated protein kinase
MAST military anti-​shock trousers
MCN mucinous cystic neoplasm
MCV mean cell volume
MDT multidisciplinary team
 Abbreviations xvii

MELD model for end-​stage liver disease

MEN multiple endocrine neoplasia
MI myocardial infarction
mm millimetre
MMC mitomycin C
MMF mycophenolate mofetil
MPA mycophenolic acid
MPACT Metastatic Pancreatic Adenocarcinoma Clinical Trial
MPSRUS mucosal prolapse solitary rectal ulcer syndrome
MRCP magnetic resonance cholangiopancreatography
MRI magnetic resonance imaging
MRSA methicillin-​resistant staphylococcus aureus
MSI microsatellite instability
mTOR mammalian target of rapamycin
NAC neo-​adjuvant chemotherapy
NASH non-​alchoholic steatohepatitis
NET neuroendocrine tumours
NG nasogastric
NICE National Institute for Health and Care Excellence
NK natural killer
NNT number needed to treat
NPI Nottingham prognostic index
NPWT negative pressure wound therapy
NRP normothermic regional perfusion
NSAID non-​steroidal anti-​inflammatory drugs
NST no special type
OCP oral contraceptive pill
OG oesophagogastric
OGD oesophagogastroduodenoscopy
OGJ oesophago-​gastric junction
OGTT oral glucose tolerance test
O-​POSSUM oesophagogastric POSSUM
OPSI overwhelming post-​splenectomy infection
PARP poly-​ADP ribose polymerase
PCA patient-​controlled analgesia
PCB primary biliary cirrhosis
PCC prothrombin complex concentrate
PCL primary colonic lymphoma
PCP pneumocystis carinii pneumonia
xviii Abbreviations

pCR pathological complete response

PCR polymerase chain reaction
PD pancreatico-​duodenectomy/​peritoneal dialysis
PE pulmonary embolism
PEEP positive end-​expiratory pressure
PEG polyethylene glycol
PET positron emission tomography
PF pancreatic fistula/​platelet factor
PI pulsatility index
PID pelvic inflammatory disease
PMP pseudomyxoma peritonei
PNEF primitive neuroectodermal tumour
PNF primary non-​function
PPI proton pump inhibitor
P-​POSSUM Portsmouth—​Physiology and Operative Severity Score for the enUmeration of
Mortality and Morbidity
PR progesterone receptor
PRISMA Preferred Reporting Items for Systematic Reviews and Meta-​Analyses
PSA persistent sciatic artery
PSC primary sclerosing cholangitis
PT partial thromboplastin/​prothrombin time
PTC percutaneous transhepatic cholangiography
PTDM post-​transplant diabetes mellitus
PTFE polytetrafluoroethylene
PTH parathyroid hormone
PTLD post-​transplant lymphoproliferative disease
PVE portal vein embolization
QDS quarter die sumendus/​four times a day
rAAA ruptured abdominal aortic aneurysm
RBC red blood cell
RCT randomized controlled trials
RFA radio-​frequency ablation
rhTSH recombinant TSH
RIF right iliac fossa
RLN recurrent laryngeal nerve
RNA ribonucleic acid
RR respiratory rate
RRA radioiodine remnant ablation
RRT renal replacement therapy
 Abbreviations xix

RT radiotherapy
RTA road traffic accident
RUQ right upper quadrant
SBA single best answer/​small bowel adenocarcinoma
SBLA sarcoma breast leukaemia adrenal
SBO small bowel obstruction
sc subcutaneous
SC sternoclavicular
SCA serous cystadenomas
SCC squamous cell carcinoma
SCD sub-​acute combined degeneration
SCFR stem cell growth factor receptor
SD standard deviation
SDD selective decontamination of the digestive tract
SEMS self-​expanding metal stent
SFA superficial femoral artery
SGAP superior gluteal artery perforator
SIEA superficial inferior epigastric artery
SIGN Scottish Intercollegiate Guidelines Network
SIL squamous intraepithelial lesion
SIRS systemic inflammatory response syndrome
SIRT selective internal radiotherapy
SLE systemic lupus erythematosus
SMA superior mesenteric artery
SMV superior mesenteric vein
SNAP Sepsis, Nutrition, Anatomy, and then a Plan
SPECT single-​photon emission CT
SPINK serine protease inhibitor Kazal-​type 
SPK simultaneous pancreas and kidney
SPN solid pseudopapillary neoplasm
SQUIRE Standards for QUality Improvement Reporting Excellence
SRUS solitary rectal ulcer syndrome
STI sexually transmitted infection
STROBE STrengthening the Reporting of OBservational studies in Epidemiology
TA Takayasu’s arteritis
TACE trans-​arterial chemoembolization
TB tuberculosis
TBMR T-​cell-​mediated rejection
TCMR T-​cell mediated rejection
xx Abbreviations

TDAP thoracodorsal artery perforator

TDS Ter die sumendum/​three times a day
TFT thyroid function test
TG thyroglobulin
TIA transient ischaemic attack
TIPS trans-​jugular portosystemic shunt
TME total mesorectal excision
TNF tumour necrosis factor
TPN total parenteral nutrition
TPO thyroid peroxidase
TRAb thyroid receptor antibodies
TRAM transverse rectus abdominus myocutaneous
TRAS transplant renal arterial stenosis
TRIPOD Transparent Reporting of a multivariable prediction model for individual Prognosis
or Diagnosis
TUG transverse upper gracilis
U&E urea and electrolytes
UC ulcerative colitis
UFH unfractionated heparin
UK United Kingdom
US ultrasound/​United States
USS ultrasound scan
UW University of Wisconsin
VAP ventilator-​associated pneumonia
VEGF vascular endothelial growth factor
VHL Von Hippel–​Lindau
V-​POSSUM vascular POSSUM
VQ ventilation/​perfusion
VTE venous thromboembolism
WCC white cell count
WLE wide local excision
WHO World Health Organization
Wnt wingless type
WON walled-​off necrosis
YAG yttrium aluminium garnet
 CONTRIBUTORS

Emma Aitken Specialty Registrar in General Surgery, Queen Elizabeth University Hospital,
Glasgow, UK
Natasha Amiraraghi Specialty Registrar in ENT, Queen Elizabeth University Hospital,
Glasgow, UK
Alexander Binning Clinical Director for Critical Care, NHS Greater Glasgow and Clyde, UK
David Chang Senior Lecturer in Surgery, Glasgow Royal Infirmary, UK
Robert Docking Consultant in Anaesthetics and Critical Care, Queen Elizabeth University
Hospital, Glasgow, UK
Graeme Guthrie Specialty Registrar in Vascular Surgery, Ninewells Hospital, Dundee, UK
Omar Hilmi Consultant ENT surgeon, Queen Elizabeth University Hospital, Glasgow, UK
Andrew Jackson Specialist Registrar, Transplant and General Surgery, Queen Elizabeth University
Hospital, Glasgow, UK
Nigel Jamieson Lecturer in Surgery, Glasgow Royal Infirmary, UK
Fiona Leitch Consultant General and Colorectal Surgeon, Forth Valley Royal Hospital,
Larbert, UK
Graham J. MacKay Consultant Colorectal Surgeon & Honorary Associate Professor, Glasgow
Royal Infirmary, UK
Fraser Maxwell Honorary Colorectal Fellow, Bankstown Hospital, Sydney, Australia
Donald McArthur Consultant General and Upper GI Surgeon, Queen Elizabeth University
Hospital, Glasgow, UK
Andrew McCulloch Consultant Cardiologist and Physician, Inverclyde Royal Hospital,
Greenock, UK
Jennifer McIlhenny Consultant Oncoplastic Breast Surgeon, Forth Valley Royal Hospital,
Larbert, UK
Richard G. Molloy Consultant Colorectal Surgeon, Queen Elizabeth University Hospital, UK
Lisa Moyes Consultant General and Colorectal Surgeon, Queen Elizabeth University Hospital,
Glasgow, UK
Gary Nicholson Consultant General and Colorectal Surgeon, Queen Elizabeth University
Hospital, Glasgow, UK
Raymond Oliphant Consultant Colorectal Surgeon, Raigmore Hospital, Inverness, UK
xxii Contributors

Martha M. Quinn Consultant in Surgical Oncology, Glasgow Royal Infirmary, Glasgow UK

Lia Paton Consultant in Anaesthetics and Critical Care, Glasgow Royal Infirmary, UK
Thaven Ramachandren Vascular Registrar, The Royal Adelaide Hospital, Adelaide, South
Australia
Judith Reid Consultant Breast Surgeon, Crosshouse Hospital, Kilmarnock, UK
Campbell S. Roxburgh Clinical Senior Lecturer and Honorary Consultant Colorectal Surgeon,
Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of
Glasgow, UK
Sheila Stallard Consultant Breast Surgeon, Gartnavel General Hospital, Glasgow, UK
Karen Stevenson Consultant Transplant Surgeon, Queen Elizabeth University Hospital,
Glasgow, UK
Brian Stewart Lecturer in Surgery, University of Glasgow, UK
Stuart Suttie Consultant Vascular Surgeon, Ninewells Hospital, Dundee, UK
Carol Watson Consultant General and Endocrine Surgeon, Queen Elizabeth University Hospital,
Glasgow, UK
 ­chapter BASIC SCIENCE

 QUESTIONS

Single Best Answers

. Dabigatran, a direct oral anticoagulant, may be best reversed by:

a) Vitamin K
b) Beriplex
c) Protamine
d) Idarucizumab
e) Fresh frozen plasma

2. A patient planned for elective inguinal hernia repair is taking Apixaban

for recurrent venous thromboembolism. How long before surgery
should the patient stop the medication?
a) 2 hours
b) 24 hours
c) 48 hours
d) Five days
e) Seven days

3. During preoperative workup, a patient’s coagulation screen comes back

with the following results: PT 2sec, APTT 47sec, Thrombin time 4sec.
The most likely explanation is
a) Alcoholic liver disease
b) Current low molecular weight heparin therapy
c) Factor VII deficiency
d) Lupus anticoagulant
e) Warfarin therapy
2 Basic Science | QUESTIONS

4. A patient reports a history of heparin-​induced thrombocytopenia

(HIT) whilst being treated with unfractionated heparin. Which of
the following would be a suitable agent for prophylaxis of venous
thromboembolism (VTE)?
a) Clopidogrel
b) Dalteparin
c) Enoxaparin
d) Fondaparinux
e) Tinzaparin

5. Which of the following infections is a patient at increased risk of

following an emergency splenectomy?
a) Staphylococcus aureus
b) Staphylococcus epidermidis
c) Clostridium difficile
d) Streptococcus pneumoniae
e) Legionella pneumophila

6. An otherwise healthy 3 year old girl presents with bilateral leg swelling.
What is the most likely diagnosis?
a) Congenital lymphoedema
b) Lymphoedema praecox
c) Congestive cardiac failure
d) Lymphoedema tarda
e) Bilateral deep venous thrombosis

7. A patient with myasthenia gravis is referred for thymectomy. What is

the embryological origin of the thymus gland?
a) First pharyngeal pouch
b) Third pharyngeal pouch
c) First pharyngeal arch
d) Thyroglossal duct
e) Rathke’s pouch

8. A 57 year old woman presents with squamous cell carcinoma of her

anus. Which is the most likely aetiological agent?
a) Human papilloma virus
b) Epstein–​Barr virus
c) Human Herpes virus 8
d) Coxsackie virus
e) Varicella Zoster virus
 Basic Science | QUESTIONS 3

9. A patient with multiple liver metastases from colonic carcinoma is

discussed at the multidisciplinary team (MDT) meeting. Which of the
following oncogenes might it be useful to test for?
a) p53
b) HER-​2
c) KRAS
d) BCR–​ABL
e) EGFR

0. A 64 year old man with a permanent cardiac pacemaker is scheduled

for elective laparoscopic cholecystectomy. He is known to be pacing-​
dependent. Which of the following strategies would deal best with the
effect of diathermy on his pacemaker?
a) Monopolar diathermy
b) Monopolar diathermy limited to short bursts
c) Bipolar diathermy
d) Clinical magnet secured on top of pacemaker
e) Pacemaker reprogramming by cardiology department

. A 32 year old female patient is about to undergo an elective repair of

a paraumbilical hernia. Which of the following skin preparation agents
would be most appropriate to use?
a) 2% aqueous chlorhexidine
b) 2% alcoholic chlorhexidine
c) 0.5% alcoholic chlorhexidine
d) Aqueous povidone-​iodine solution
e) Isopropyl alcohol

2. When a patient is immobilized their body undergoes major changes

to the cardiovascular and musculoskeletal systems and to the blood
volume. Approximately how long after continued bed rest are these
changes seen?
a) Three days
b) Seven days
c) 4 days
d) 2 days
e) 42 days
4 Basic Science | QUESTIONS

3. Which of the following biochemical markers is least likely to show

evidence of depletion in a patient who has nutrition reintroduced after
4 days of starvation?
a) Magnesium
b) Phosphate
c) Potassium
d) Sodium
e) Thiamine

4. What is the mode of inheritance of Peutz–​Jeghers syndrome?

a) Autosomal dominant
b) Autosomal recessive
c) Epigenetic
d) Mitochondrial
e) X-​linked recessive

5. During a sleeve gastrectomy the right gastroepiploic artery is divided.

Which vessel does this artery arise from?
a) Gastroduodenal artery
b) Hepatic artery
c) Right gastric artery
d) Splenic artery
e) Superior pancreatico-​duodenal artery

6. A new chemotherapy regime for colorectal cancer was tested in 2000
patients with Dukes stage C. 000 patients received the new regime
while the other 000 received standard therapy. Five-​year survival in
the standard therapy group is 65% versus 75% in the new regime group.
What is the number needed to treat (NNT)?
a) 5
b) 0
c) 20
d) 50
e) 00

7. A patient sustains a head injury in a road traffic accident. In the

assessment of his cranial nerves, which is the most likely to have been
injured?
a) I—​Olfactory
b) III—​Oculomotor
c) V—​Trigeminal
d) VI—​Abducens
e) VII—​Facial
 Basic Science | QUESTIONS 5

8. An alternating magnetic field induced by a high-​frequency alternating

current may result in electrical currents in nearby conducting objects
such as metal laparoscopic trochars. Such a phenomenon is known as:
a) Capacitance coupling
b) Impedance
c) Electromagnetic stimulation
d) Bipolar diathermy
e) Electrical arcing

9. Which of the following treatment options is not advisable in the

management of adult respiratory distress syndrome (ARDS)?
a) High-​frequency oscillatory ventilation
b) Prone-​position ventilation
c) Applying positive end expiratory pressure
d) Use of diuretics
e) Increasing ventilatory tidal volumes

20. Which skin condition is associated with gastrointestinal (GI) malignancy

and characterized by a thickened, pigmented, predominantly
flexural rash?
a) Erythema ab igne
b) Dermatitis herpetiformis
c) Dermatomyositis
d) Acanthosis nigricans
e) Thrombophlebitis migrans

2. Which of the following options is not a potential adverse effect of massive
blood transfusion?
a) Coagulopathy
b) Hypercalcaemia
c) Hyperkalaemia
d) Hypothermia
e) Hypoxia

22. The lower limit of the spinal cord in adults lies at the level of:
a) T/​2
b) L/​2
c) L3/​4
d) L5/​S
e) S4/​5
6 Basic Science | QUESTIONS

23. A 34 year old welder arrives in the resuscitation room after an apparent
industrial accident. He has a large laceration in his proximal right
thigh. The paramedics report considerable blood loss at the scene. He
appears pale and is obviously agitated, shouting inappropriately. His
pulse is 33bpm and his blood pressure is 80/​58mmHg. Which class of
haemorrhagic shock is he likely to fall into, allowing an estimation of
blood loss?
a) Class I, <750ml, 5% of total volume
b) Class II, 750–​500ml, 5–​30% of total volume
c) Class III, 500–​2000ml, 30–​40% of total volume
d) Class IV, >2000ml, >40% of total volume
e) Class V, >3000ml, >60% of total volume

24. Regarding intra-​abdominal hypertension and abdominal compartment

syndrome, which of the following statements is true?
a) Diagnosis of abdominal compartment syndrome requires an intra-​abdominal pressure of
>25mmHg.
b) Normal intra-​abdominal pressure is 5–​9mmHg.
c) The reference standard for intra-​abdominal pressure measurement is via the bladder with a
maximum volume of 00ml sterile saline.
d) Abdominal compartment syndrome is defined as an intra-​abdominal pressure >20mmHg
with associated organ dysfunction.
e) Abdominal perfusion pressure = mean arterial pressure + intra-​abdominal pressure

25. Exogenous injury to cells resulting in denaturing of proteins and

degradation by proteolytic enzymes is known as:
a) Apoptosis
b) Atrophy
c) Necrosis
d) Autophagy
e) Senescence

26. Which of the following terms indicates a malignant neoplasm originating

within striated muscle tissue?
a) Leiomyosarcoma
b) Rhabdomyosarcoma
c) Malignant teratoma
d) Carcinosarcoma
e) Sternocleidomastoid tumour
Another random document with
no related content on Scribd:
vaan tulevan totuuden tuntoon; ja sentähden uskon minä, etten
huku, vaan tulen tietämään totuuden Sinusta, omasta luonteestani,
minun velvollisuuksistani ja kaikesta, mitä tarvitsen tietää.
Sentähden, oi Herra, tahdon minä käydä rohkeasti eteenpäin ja
täyttää velvollisuuteni niin hyvin kuin voin päivä päivältä, joskaan en
täydellisesti, ja rukoilla Sinua päivä päivältä ravitsemaan minun
sieluni jokapäiväsellä leivällä. Sinä ravitset ruumiini jokapäiväsellä
leivällä. Kuinka paljoa enemmän sinä tahdot ravita minun olentoni ja
sydämeni, joka on paljoa suuremman arvoinen Sinulle kuin minun
ruumiini. Herra, minä tahdon uskoa Sinuun sekä ruumiin että sielun
puolesta; ja minua tarvitaan oikaista synteini tähden, tiedän minä
hyvinkin sen, että pahinta, jota voipi tapahtua minulle tai jollekin
ihmiselle, on tehdä väärin eikä tulla oikaistuksi, ja parasta on saada
ohjausta oikeaan, vaikkakin kovain iskujen kautta, niin usein kuin
minä eksyn pois tieltä. Sentähden, oi Herra, tahdon minä kärsiä
rangaistukseni hiljaa ja miehuullisesti ja koettaa kiittää Sinua siitä,
niinkuin minun pitäisi; sillä minä tiedän ett'et tahdo rangaista minua
enempi kuin ansaitsen, vaan paljoa vähemmän kuin ansaitsen. Minä
tiedän että Sinä tahdot rangaista minua ainoasti saadaksesi minua
menemään itseeni ja oikasemaan itseäni, puhdistaakseni itseäni ja
vahvistaakseni itseäni. Oi Herra, minä uskon, Sinun oman sanasi
tähden minä uskon sen — ansaitsematta niinkuin se kunnia, että
Sinä olet minun Isäni ja rakastat minua; Sinä et vaivaa ketään
ihmistä halulla etkä saata murhetta ihmisten lapsille huonoista
vaikuttimista tai uhalla. Sinä et tahdo minun tai kenenkään muun
ihmisen kadotusta; vaan Sinä tahdot että kaikki ihmiset autuaiksi ja
totuuden tuntoon tulisivat Jesuksen Kristuksen tähden. Amen.

Ahdistetun sielun tunnustus.

 Oi Herra, minä olen hädässä — minun sieluni on sangen rauhaton
— sillä minä olen syntiä tehnyt, ja minä tunnustan saavani ainoasti
töitteni ansion mukaisen palkan. Minä olen häpeäni ansainnut, minä
olen suruni ansainnut, oi Herra, minä olen ansainnut kaikki tyyni.
Minä katson taaksepäin menetettyyn aikaan ja menetettyyn
voimaan. Minä katson ympärilleni ja näen menetetyn terveyden,
menetetyn omaisuuden, kadotetun toivon; minä tunnustan sen
kaiken ansaitsevani. Mutta Sinä olet kantanut enempi kuin tämän
minun tähteni; etkä Sinä ole mitään turhaan tehnyt. Minun edestäni
olet Sinä kärsinyt; minun edestäni olet Sinä ristiinnaulittu, ja minua
olet Sinä koettanut vapahtaa kaikkina niinä vuosina, joita olen
turhuudessa viettänyt. Ehkä en ole kuitenkaan väsyttänyt Sinun
rakkauttasi; ehkä en ole lopettanut Sinun kärsivällisyyttäsi. Minä
tahdon uskoa vielä yhteen siunattuun mahdollisuuteen. Minä tahdon
vielä heittäytyä Sinun rakkautesi varaan. Oi Herra, minä olen
ansainnut kaiken kurjuuteni. Kuitenkin, Herra, muista minua, kun
tulet valtakuntaasi! Luk. 23:42. Amen!

Isä! elköön meidän tahtomme tapahtuko, vaan Sinun. Kaikki

tulevat Sinun kädestäsi, ja sentähden tulevat kaikki Sinun
rakkaudestasi. Me olemme saaneet hyvää Sinun kädestäsi, emmekö
sitte ottaisi vastaan pahaakin? Vaikkakin Sinä lyöt meitä, uskomme
Sinuun. Sillä Sinä olet armollinen ja laupias, pitkämielinen ja kovin
hyvä. Sinä olet täynnä rakkautta jokaista ihmistä kohtaan, ja Sinä
säälit kaikkia Sinun luomiasi. Sinä olet vanhurskas kaikissa Sinun
teissäsi ja pyhä kaikissa töissäsi. Sinä olet lähellä kaikkia niitä, jotka
huutavat Sinun puoleesi. Sinä tahdot kuulla heidän huutonsa ja
auttaa heitä; sillä Sinä toivot lähettäessäsi hätää meille, että
tulisimme viisaammiksi ja paremmiksi. Ja sen voit Sinä tehdä
ainoasti opettamalla meitä tuntemaan Sinua. Kunnia olkoon Sinulle,
oi Jumala! Amen.
*** END OF THE PROJECT GUTENBERG EBOOK SYVYYDESTÄ
***

Updated editions will replace the previous one—the old editions will
be renamed.

Creating the works from print editions not protected by U.S.

copyright law means that no one owns a United States copyright in
these works, so the Foundation (and you!) can copy and distribute it
in the United States without permission and without paying copyright
royalties. Special rules, set forth in the General Terms of Use part of
this license, apply to copying and distributing Project Gutenberg™
electronic works to protect the PROJECT GUTENBERG™ concept
and trademark. Project Gutenberg is a registered trademark, and
may not be used if you charge for an eBook, except by following the
terms of the trademark license, including paying royalties for use of
the Project Gutenberg trademark. If you do not charge anything for
copies of this eBook, complying with the trademark license is very
easy. You may use this eBook for nearly any purpose such as
creation of derivative works, reports, performances and research.
Project Gutenberg eBooks may be modified and printed and given
away—you may do practically ANYTHING in the United States with
eBooks not protected by U.S. copyright law. Redistribution is subject
to the trademark license, especially commercial redistribution.

START: FULL LICENSE

THE FULL PROJECT GUTENBERG LICENSE
 PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK

To protect the Project Gutenberg™ mission of promoting the free

distribution of electronic works, by using or distributing this work (or
any other work associated in any way with the phrase “Project
Gutenberg”), you agree to comply with all the terms of the Full
Project Gutenberg™ License available with this file or online at
www.gutenberg.org/license.

Section 1. General Terms of Use and

Redistributing Project Gutenberg™
electronic works
1.A. By reading or using any part of this Project Gutenberg™
electronic work, you indicate that you have read, understand, agree
to and accept all the terms of this license and intellectual property
(trademark/copyright) agreement. If you do not agree to abide by all
the terms of this agreement, you must cease using and return or
destroy all copies of Project Gutenberg™ electronic works in your
possession. If you paid a fee for obtaining a copy of or access to a
Project Gutenberg™ electronic work and you do not agree to be
bound by the terms of this agreement, you may obtain a refund from
the person or entity to whom you paid the fee as set forth in
paragraph 1.E.8.

1.B. “Project Gutenberg” is a registered trademark. It may only be

used on or associated in any way with an electronic work by people
who agree to be bound by the terms of this agreement. There are a
few things that you can do with most Project Gutenberg™ electronic
works even without complying with the full terms of this agreement.
See paragraph 1.C below. There are a lot of things you can do with
Project Gutenberg™ electronic works if you follow the terms of this
agreement and help preserve free future access to Project
Gutenberg™ electronic works. See paragraph 1.E below.
1.C. The Project Gutenberg Literary Archive Foundation (“the
Foundation” or PGLAF), owns a compilation copyright in the
collection of Project Gutenberg™ electronic works. Nearly all the
individual works in the collection are in the public domain in the
United States. If an individual work is unprotected by copyright law in
the United States and you are located in the United States, we do
not claim a right to prevent you from copying, distributing,
performing, displaying or creating derivative works based on the
work as long as all references to Project Gutenberg are removed. Of
course, we hope that you will support the Project Gutenberg™
mission of promoting free access to electronic works by freely
sharing Project Gutenberg™ works in compliance with the terms of
this agreement for keeping the Project Gutenberg™ name
associated with the work. You can easily comply with the terms of
this agreement by keeping this work in the same format with its
attached full Project Gutenberg™ License when you share it without
charge with others.

1.D. The copyright laws of the place where you are located also
govern what you can do with this work. Copyright laws in most
countries are in a constant state of change. If you are outside the
United States, check the laws of your country in addition to the terms
of this agreement before downloading, copying, displaying,
performing, distributing or creating derivative works based on this
work or any other Project Gutenberg™ work. The Foundation makes
no representations concerning the copyright status of any work in
any country other than the United States.

1.E. Unless you have removed all references to Project Gutenberg:

1.E.1. The following sentence, with active links to, or other

immediate access to, the full Project Gutenberg™ License must
appear prominently whenever any copy of a Project Gutenberg™
work (any work on which the phrase “Project Gutenberg” appears, or
with which the phrase “Project Gutenberg” is associated) is
accessed, displayed, performed, viewed, copied or distributed:
 This eBook is for the use of anyone anywhere in the United
States and most other parts of the world at no cost and with
almost no restrictions whatsoever. You may copy it, give it away
or re-use it under the terms of the Project Gutenberg License
included with this eBook or online at www.gutenberg.org. If you
are not located in the United States, you will have to check the
laws of the country where you are located before using this
eBook.

1.E.2. If an individual Project Gutenberg™ electronic work is derived

from texts not protected by U.S. copyright law (does not contain a
notice indicating that it is posted with permission of the copyright
holder), the work can be copied and distributed to anyone in the
United States without paying any fees or charges. If you are
redistributing or providing access to a work with the phrase “Project
Gutenberg” associated with or appearing on the work, you must
comply either with the requirements of paragraphs 1.E.1 through
1.E.7 or obtain permission for the use of the work and the Project
Gutenberg™ trademark as set forth in paragraphs 1.E.8 or 1.E.9.

1.E.3. If an individual Project Gutenberg™ electronic work is posted

with the permission of the copyright holder, your use and distribution
must comply with both paragraphs 1.E.1 through 1.E.7 and any
additional terms imposed by the copyright holder. Additional terms
will be linked to the Project Gutenberg™ License for all works posted
with the permission of the copyright holder found at the beginning of
this work.

1.E.4. Do not unlink or detach or remove the full Project

Gutenberg™ License terms from this work, or any files containing a
part of this work or any other work associated with Project
Gutenberg™.

1.E.5. Do not copy, display, perform, distribute or redistribute this

electronic work, or any part of this electronic work, without
prominently displaying the sentence set forth in paragraph 1.E.1 with
active links or immediate access to the full terms of the Project
Gutenberg™ License.
1.E.6. You may convert to and distribute this work in any binary,
compressed, marked up, nonproprietary or proprietary form,
including any word processing or hypertext form. However, if you
provide access to or distribute copies of a Project Gutenberg™ work
in a format other than “Plain Vanilla ASCII” or other format used in
the official version posted on the official Project Gutenberg™ website
(www.gutenberg.org), you must, at no additional cost, fee or expense
to the user, provide a copy, a means of exporting a copy, or a means
of obtaining a copy upon request, of the work in its original “Plain
Vanilla ASCII” or other form. Any alternate format must include the
full Project Gutenberg™ License as specified in paragraph 1.E.1.

1.E.7. Do not charge a fee for access to, viewing, displaying,

performing, copying or distributing any Project Gutenberg™ works
unless you comply with paragraph 1.E.8 or 1.E.9.

1.E.8. You may charge a reasonable fee for copies of or providing

access to or distributing Project Gutenberg™ electronic works
provided that:

• You pay a royalty fee of 20% of the gross profits you derive from
the use of Project Gutenberg™ works calculated using the
method you already use to calculate your applicable taxes. The
fee is owed to the owner of the Project Gutenberg™ trademark,
but he has agreed to donate royalties under this paragraph to
the Project Gutenberg Literary Archive Foundation. Royalty
payments must be paid within 60 days following each date on
which you prepare (or are legally required to prepare) your
periodic tax returns. Royalty payments should be clearly marked
as such and sent to the Project Gutenberg Literary Archive
Foundation at the address specified in Section 4, “Information
about donations to the Project Gutenberg Literary Archive
Foundation.”

• You provide a full refund of any money paid by a user who

notifies you in writing (or by e-mail) within 30 days of receipt that
s/he does not agree to the terms of the full Project Gutenberg™
 License. You must require such a user to return or destroy all
copies of the works possessed in a physical medium and
discontinue all use of and all access to other copies of Project
Gutenberg™ works.

• You provide, in accordance with paragraph 1.F.3, a full refund of

any money paid for a work or a replacement copy, if a defect in
the electronic work is discovered and reported to you within 90
days of receipt of the work.

• You comply with all other terms of this agreement for free
distribution of Project Gutenberg™ works.

1.E.9. If you wish to charge a fee or distribute a Project Gutenberg™

electronic work or group of works on different terms than are set
forth in this agreement, you must obtain permission in writing from
the Project Gutenberg Literary Archive Foundation, the manager of
the Project Gutenberg™ trademark. Contact the Foundation as set
forth in Section 3 below.

1.F.

1.F.1. Project Gutenberg volunteers and employees expend

considerable effort to identify, do copyright research on, transcribe
and proofread works not protected by U.S. copyright law in creating
the Project Gutenberg™ collection. Despite these efforts, Project
Gutenberg™ electronic works, and the medium on which they may
be stored, may contain “Defects,” such as, but not limited to,
incomplete, inaccurate or corrupt data, transcription errors, a
copyright or other intellectual property infringement, a defective or
damaged disk or other medium, a computer virus, or computer
codes that damage or cannot be read by your equipment.

1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except

for the “Right of Replacement or Refund” described in paragraph
1.F.3, the Project Gutenberg Literary Archive Foundation, the owner
of the Project Gutenberg™ trademark, and any other party
distributing a Project Gutenberg™ electronic work under this
agreement, disclaim all liability to you for damages, costs and
expenses, including legal fees. YOU AGREE THAT YOU HAVE NO
REMEDIES FOR NEGLIGENCE, STRICT LIABILITY, BREACH OF
WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE
PROVIDED IN PARAGRAPH 1.F.3. YOU AGREE THAT THE
FOUNDATION, THE TRADEMARK OWNER, AND ANY
DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE LIABLE
TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL,
PUNITIVE OR INCIDENTAL DAMAGES EVEN IF YOU GIVE
NOTICE OF THE POSSIBILITY OF SUCH DAMAGE.

1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you

discover a defect in this electronic work within 90 days of receiving it,
you can receive a refund of the money (if any) you paid for it by
sending a written explanation to the person you received the work
from. If you received the work on a physical medium, you must
return the medium with your written explanation. The person or entity
that provided you with the defective work may elect to provide a
replacement copy in lieu of a refund. If you received the work
electronically, the person or entity providing it to you may choose to
give you a second opportunity to receive the work electronically in
lieu of a refund. If the second copy is also defective, you may
demand a refund in writing without further opportunities to fix the
problem.

1.F.4. Except for the limited right of replacement or refund set forth in
paragraph 1.F.3, this work is provided to you ‘AS-IS’, WITH NO
OTHER WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED,
INCLUDING BUT NOT LIMITED TO WARRANTIES OF
MERCHANTABILITY OR FITNESS FOR ANY PURPOSE.

1.F.5. Some states do not allow disclaimers of certain implied

warranties or the exclusion or limitation of certain types of damages.
If any disclaimer or limitation set forth in this agreement violates the
law of the state applicable to this agreement, the agreement shall be
interpreted to make the maximum disclaimer or limitation permitted
by the applicable state law. The invalidity or unenforceability of any
provision of this agreement shall not void the remaining provisions.

1.F.6. INDEMNITY - You agree to indemnify and hold the

Foundation, the trademark owner, any agent or employee of the
Foundation, anyone providing copies of Project Gutenberg™
electronic works in accordance with this agreement, and any
volunteers associated with the production, promotion and distribution
of Project Gutenberg™ electronic works, harmless from all liability,
costs and expenses, including legal fees, that arise directly or
indirectly from any of the following which you do or cause to occur:
(a) distribution of this or any Project Gutenberg™ work, (b)
alteration, modification, or additions or deletions to any Project
Gutenberg™ work, and (c) any Defect you cause.

Section 2. Information about the Mission of

Project Gutenberg™
Project Gutenberg™ is synonymous with the free distribution of
electronic works in formats readable by the widest variety of
computers including obsolete, old, middle-aged and new computers.
It exists because of the efforts of hundreds of volunteers and
donations from people in all walks of life.

Volunteers and financial support to provide volunteers with the

assistance they need are critical to reaching Project Gutenberg™’s
goals and ensuring that the Project Gutenberg™ collection will
remain freely available for generations to come. In 2001, the Project
Gutenberg Literary Archive Foundation was created to provide a
secure and permanent future for Project Gutenberg™ and future
generations. To learn more about the Project Gutenberg Literary
Archive Foundation and how your efforts and donations can help,
see Sections 3 and 4 and the Foundation information page at
www.gutenberg.org.
 Section 3. Information about the Project
Gutenberg Literary Archive Foundation
The Project Gutenberg Literary Archive Foundation is a non-profit
501(c)(3) educational corporation organized under the laws of the
state of Mississippi and granted tax exempt status by the Internal
Revenue Service. The Foundation’s EIN or federal tax identification
number is 64-6221541. Contributions to the Project Gutenberg
Literary Archive Foundation are tax deductible to the full extent
permitted by U.S. federal laws and your state’s laws.

The Foundation’s business office is located at 809 North 1500 West,

Salt Lake City, UT 84116, (801) 596-1887. Email contact links and up
to date contact information can be found at the Foundation’s website
and official page at www.gutenberg.org/contact

Section 4. Information about Donations to

the Project Gutenberg Literary Archive
Foundation
Project Gutenberg™ depends upon and cannot survive without
widespread public support and donations to carry out its mission of
increasing the number of public domain and licensed works that can
be freely distributed in machine-readable form accessible by the
widest array of equipment including outdated equipment. Many small
donations ($1 to $5,000) are particularly important to maintaining tax
exempt status with the IRS.

The Foundation is committed to complying with the laws regulating

charities and charitable donations in all 50 states of the United
States. Compliance requirements are not uniform and it takes a
considerable effort, much paperwork and many fees to meet and
keep up with these requirements. We do not solicit donations in
locations where we have not received written confirmation of
compliance. To SEND DONATIONS or determine the status of
compliance for any particular state visit www.gutenberg.org/donate.

While we cannot and do not solicit contributions from states where

we have not met the solicitation requirements, we know of no
prohibition against accepting unsolicited donations from donors in
such states who approach us with offers to donate.

International donations are gratefully accepted, but we cannot make

any statements concerning tax treatment of donations received from
outside the United States. U.S. laws alone swamp our small staff.

Please check the Project Gutenberg web pages for current donation
methods and addresses. Donations are accepted in a number of
other ways including checks, online payments and credit card
donations. To donate, please visit: www.gutenberg.org/donate.

Section 5. General Information About Project

Gutenberg™ electronic works
Professor Michael S. Hart was the originator of the Project
Gutenberg™ concept of a library of electronic works that could be
freely shared with anyone. For forty years, he produced and
distributed Project Gutenberg™ eBooks with only a loose network of
volunteer support.

Project Gutenberg™ eBooks are often created from several printed

editions, all of which are confirmed as not protected by copyright in
the U.S. unless a copyright notice is included. Thus, we do not
necessarily keep eBooks in compliance with any particular paper
edition.

Most people start at our website which has the main PG search
facility: www.gutenberg.org.

This website includes information about Project Gutenberg™,

including how to make donations to the Project Gutenberg Literary
Archive Foundation, how to help produce our new eBooks, and how
to subscribe to our email newsletter to hear about new eBooks.