Question 1698 of 2943 An 89-year-old lady is admitted with mechanical bowel obstruction and is commenced on total parenteral nutrition Which of the following statements regarding parenteral nutrition is correct? B Hepatic dysfunction commonly occurs as a result of parenteral nutrition C Perioperative administration leads to a lower anastomotic dehiscence rate D Solutions are generally isotonic E The nitrogen content should be 40g/day Explanation TPN solutions are hypertonic which is why they are usually given centrally, although the peripheral route is sometimes used. 149 of nitrogen is the usual daily amount given. Malnutrition in a surgical patient will lead to a higher complication rate but there is no evidence that routine use of TPN will have any beneficial effect on complication rates and may possibly increase it. Hepatic dysfunction with cholestasis and abnormal LFTs is a specific complication associated with TPN although only occurs in a small percentage of cases.Question 1699 of 2943 Which one of the following muscles in the hand is supplied by the median nerve? A Radial two interossei C Ulnar two lumbricales D — Adductor pollicis — Extensor pollicis Explanation Ls The abductor pollicis brevis is one of the four LOAF muscles supplied by the median nerve in the hand (the others are the lateral two lumbricals, opponens pollicis and flexor pollicis brevis). It lies superficially and radially in the thenar eminence, and is used to test median nerve function in the hand via the median nerve's recurrent motor branch. Recall that abduction of the thumb is bringing it away from the palm.