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A 68-year-old woman presents with a bimalleolar fracture of the right ankle. Operative fixation is undertaken using a direct lateral approach to the lateral malleolus, with a direct incision used for the medial malleolus. Which one of the following structures is found anterior to the medial malleolus? A B C D E Flexor digitorum longus tendon Posterior tibial artery Saphenous nerve Tibial nerve Tibialis posterior tendon 6. A 43-year-old woman presents with lumbar back pain and sciatica, with associated numbness over the lateral border of the right foot and ankle, along with an absent ipsilateral ankle jerk.

The other options are likely to increase rather than decrease anxiety. B Activation of the extrinsic clotting pathway by products of tissue damage With multiple injuries this woman is a typical candidate for the generation of products which activate the extrinsic (extravascular) clotting pathway. These products then enter the blood stream and activate the final stages of the clotting pathway, by passing the initial intrinsic (intravascular) pathway. Fibrin is laid down widely in the circulation, depleting circulating fibrinogen so that, paradoxically, excessive clotting leads to a risk of excessive bleeding.

In neurogenic shock, which is the most important contributor to hypotension? A B C D E Decreased parasympathetic tone Decreased circulating volume Increased sympathetic tone Increased systemic vascular resistance Increased venous capacitance 5. An 84-year-old man is in the surgical high dependency unit the morning following laparotomy for a perforated duodenal ulcer. He had an episode of chest pain and dyspnoea overnight and is now hypotensive and tachycardic with cool peripheries and a raised jugular venous pressure.

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