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The previous question:

How does lactulose work?

Your answer was Reduced gastric motility which is incorrect

Softens faecal matter correct answer
Increased motility
Bulk forming laxative
Increased faecal pH
Reduced gastric motility


Lactulose is an osmotic laxative and therefore acts to soften faecal matter. It has a very important role in ALD as it leads to the reduction of ammonia. This is due to the fact as it is broken down by bacteria in the lower part of the intestines which leads to the environment becoming acidic which neutralises the ammonia and reduces the amount absorbed. This leads to reduction of encephalopathy.

Question category: Respiratory

A 44 year old smoker presents with increasing shortness of breath. She states she has fainted a couple of times on exertion. On examination there is a right ventricular heave and loud pulmonary second heart sound and an ECG shows right ventricular hypertrophy. Her chest is clear. A CXR is performed and is normal. What investigation should be performed for the definitive diagnosis?

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