MRCS Part A, September 2023 - Recalls

1) Posteromedial approach Baker cyst, most superficial susceptible to damage –

Sciatic n.
Tibial n.
Sural n.
CPN
Saphenous n.

2) Neck stab, tongue deviation –

Hypoglossal n. injury

3) Chest XRAY scenario – foreign body –

Rt. lower lobe bronchus
Rt. middle lobe bronchus
Rt. main bronchus

4) Ileoanal pouch, put on long-term metronidazole. Common side effect –

Pouch fibrosis
Peripheral neuropathy
Coagulopathy
Ileovesical fistula
Pouchitis

5) Reciprocal of absolute risk reduction –

Number needed to treat

6) 17y/o, recurrent Right upper quadrant pain, hereditary spherocytosis, jaundice, increased ALP, liver enzymes. Diagnostic investigation –

ERCP
MRCP
U/S

7) 8 y/o, enlarged tonsils midline, white membrane, bleed when remove it; pyrexial, otherwise well –

Infectious mononucleosis
Acute bacterial tonsillitis
Quinsy
Lymphoma
Diphtheria

8) XRAY scenario – patient with hysterectomy scar –

Small bowel obstruction
Large bowel obstruction
Meckels
Pneumobilia

9) 50y/o, B/L cervical lymphadenopathy, hepatomegaly, fever, positive antibodies –

Infectious mononucleosis
Cat-scratch
Non-Hodgkin
Hepatitis
Epstein Barr virus

10) 34y/o lady neck swelling, diarrhoea, hypertension, diagnosis of MEN2.

Pheochromocytoma
Medullary thyroid ca
Hypoparathyroidism
Gastric ca

11) Female hematuria comes to clinic; Investigation not helpful for assessment –

CT KUB
CT Urogram
U/S
Renogram
Cystoscopy

12) Patient weak hallux extension, weak foot dorsiflexion. Posterolateral PIVD level –

L5/S1
L4/L5
L3/L4
S1/S2

13) Old patient severe penis pain after catheter. Prepuce retracted, penis swollen, engorged –

Balanitis
Balanoposthitis
Paraphimosis
Phimosis

14) Extradural hematoma on CT. One pupil fixed, dilated, GCS declined. Next step –

Admit ICU & ICP monitor
Neuroprotective measures and refer to neuro
Add mannitol

15) Chest XRAY scenario – gas under left diaphragm and gas above central diaphragm –

Oesophageal perforation
Incarcerated paraoesophageal hernia
Boerhave syndrome

16) XRAY scenario – dark shadow on Rt. iliac fossa and feculent vomiting, distended abdomen and constipation –

Caecal volvulus
Small bowel obstruction
Large bowel obstruction

17) Postoperative fluids given; high chloride on ABG and acidosis. Cause by which fluid –

N/S
Dextrose
Hartmann

18) Required resuscitation fluid for 11y/o – 34kg in 24hours with shock features –

680ml N/S stat
300ml

19) Xray barium swallow scenario –

Pharyngeal pouch
Achalasia
Oesophageal ca
Postcricoid web

20) 53y/o scrotal swelling for 2 months, can get above the swelling, testis palpable separate –

Hydrocele
Seminoma
Hernia
Epididymal cyst
Inguinoscrotal swelling

21) Stab at 5^th intercostal space just left to the sternum. Injured structure –

Rt. atrium
Rt. ventricle

22) Smoking & GERD, metaplasia of columnar epithelium in lower esophagus is explained by –

Irreversible change cell type due to external factor
Reversible change cell type due to internal factor

23) Head injury, brain hemorrhage, admitted ICU & hematemesis. Endoscopy multiple ulcers stomach, duodenum. Cause –

Zollinger-Ellison syndrome
Vagal discharge
Hypotension
Stress ulcer
NSAIDs

24) Most reliable score for preoperative mortality –

NELA
ASA
Apache II
P-POSSUM

25) After pre-clinical trial – RCT of new antiemetic drug against cyclizine done in large number of patients –

Phase I
Phase II
Phase III
Phase IV
Phase 0

26) Stroke, diabetes and punched out ulcer on hallux –

Neuropathic
Arterial
Critical limb ischemia

27) Goal directed treatment –

Protect heart
Glucose
Diuretics
Prophylactic antibiotics
Restriction of iv fluids

28) Audit – retrospective evaluation against a set standard –

Criterion audit
Outcomes audit
Standard audit
Process audit

29) Cervical vertebra injury, upper limb weaker than lower limb –

Central cord injury

30) Midtarsal fracture treated surgically. Pain after 10 years –

Avascular necrosis
Instability
Primary osteoarthritis
Secondary osteoarthritis

31) RTA patient on heparin – postop day 8, increased aPTT, normal PT, low platelets –

DIC
HIT

32) Inferior pole relation of Lt. adrenal gland –

Crus of diaphragm
Quadratus
Iliacus
Body of pancreas
L renal vein

33) Patient with Familial Adenomatous Polyposis (FAP). Polyp type –

Tubular adenoma
Hyperplastic
Villous
Peutz-Jeghers

34) Splenic artery ligation, damage after splenectomy. Area blood supply by it –

Gastric fundus
Lesser curvature
Greater curvature
Antrum

35) Froment’s test; muscle tested –

Adductor pollicis

36) Primary action of cortisol in postoperative period –

Glycolysis
Gluconeogenesis
Stimulate glycogen synthesis

37) Trauma during splenectomy (splenic vein/artery ligation) –

Tail of pancreas
Lienorenal ligament

38) Bilateral ptosis, tired with activity, lesion in superior mediastinum –

Thymus mass (thymoma)
Myasthenia gravis

39) Pain when brushing lower teeth & jaw. Nerve exits from cranium –

V3 and foramen ovale

40) Brown Sequard syndrome scenario (cord injury on left) –

Rt. sided weakness & Lt. sided pain sensation loss

41) Level of artery that provides superior rectum blood supply

42) Carpal tunnel syndrome surgery, palmar sensory loss & thenar wasting. Median nerve injury level –

Proximal to flexor retinaculum
At flexor retinaculum
Distal to flexor retinaculum

43) Osgood-Schlatter disease

Problem in later life
Rest
Self-limiting
Commoner in females than males
Treated with cast

44) Areflexia –

LMN (lower motor neuron) injury

45) Rt testicular vein drains to –

IVC

46) Polyuria after head injury scenario – where is the water absorption defect –

PCT
Collecting duct

47) Child with upper interventricular defect. Originated from –

Bulbus cordis
Sinus venosus
Septum primum
Septum secondum

48) GCS calculation – eyes opening to pain + incomprehensible words + abnormal flexion response –

49) 56y/o alcoholic, head injury, minor cut on forehead, initial GCS 13, after 2h GCS 15 –

Discharge with someone to accompany him
CT in 1h
CT in 8h
Admission
Observation

50) Starling forces – 45 hydrostatic pressure capillaries, 10 hydrostatic pressure bowman, 27 oncotic pressure capillaries, 0 oncotic pressure Bowman. Filtration pressure calculation –

51) Homonymous hemianopia –

Optic tract

52) 73y/o angina on going uphill. Cause –

Aortic sclerosis
Aortic stenosis
Aortic regurgitation
Mitral stenosis

53) What is riskier for surgical patients –

Aortic stenosis
Mitral stenosis

54) Severe pain at rest, unable to sleep and patient sleeps on chair –

Critical limb ischemia
Intermittent claudication
Neuropathic
Vascular

55) After Left carotid endarterectomy, tongue deviation to left –

Hypoglossal n. injury

56) Midline swelling from umbilicus to costal margin; prominent with head up position –

Umbilical hernia
Paraumbilical hernia
Epigastric hernia
Diastasis recti

57) Patient after abdominal surgery, hypotensive, HR increased, cold dry skin; next step of management –

Adrenaline
Bisoprolol
Noradrenaline
IV fluids

58) Line of Zahn on autopsy seen in –

Thrombus
Atheroma

59) Submandibular gland surgery. Bleeding most likely from –

Lingual artery
Facial artery

60) Radial nerve moves from anterior to posterior compartment (10cm above proximal radiocapitellar joint) –

Cubital fossa
Spiral groove

61) 42y/o bloody nipple discharge, skin tethering, retraction. No mass on examination and U/S normal. Next step –

Core biopsy
MRI
U/S in 6 months
Mammogram
FNAC

62) 3-month catheterization after pelvic trauma. Catheter removed, unable to hold urine. Injury to –

Bladder neck
External sphincter
Internal sphincter
Membranous urethra

63) Retractile testis scenario. Structure responsible –

Transversalis fascia
Internal oblique
External oblique
Transversus abdominus

64) 4 y/o penis fore-skin not retracted; management –

Circumcision
Steroid cream
Dorsal slit

65) Screening mammogram 13 mm (pleomorphic) microcalcifications, previous normal mammography –

DCIS
Fibroadenoma
Invasive lobular ca
Duct ectasia

66) Breast eczema. Paget association –

DCIS
Ductal carcinoma
LCIS
Invasive lobular ca

67) 2 cm thumb base laceration. Palm faces ceiling, thumb unable to make 90^owith palm; injured structure –

Abductor pollicis brevis
Flexor pollicis brevis
Extensor pollicis brevis

68) Non-functioning pituitary macroadenoma with severe headache & vomiting –

Hydrocephalus
Pituitary apoplexy

69) Anterior dural sac (fold) tumour with surrounding cyst capping –

Glioma
Meningioma
Glioblastoma multiforme

70) 75y/o back pain after minor fall. Osteoporotic fracture scenario –

Normocalceamia
Hypercalceamia
Hyperphosphateamia
Hypocalcaemia
Hyponatreamia

71) Old poor debilitated man, brain head injury, slow recovery. Prolonged nutrition option –

NG
Gastrostomy (PEG)
Jejunostomy
TPN

72) 70% of small bowel resected. Long nutritional option –

TPN (doubtful)
NG feeding
Nasoenteric feeding
PEG
Jejunostomy

73) Bowel resected earlier. 250 cm of residual bowel left. Nutritional option –

Oral (enteral)
TPN
Elemental diet

74) 25 y/o Appendectomy patient – smokes 5 cigarettes per day. ASA score –

75) Patient with unilateral gynecomastia. Check for –

Testis
Liver

76) Child testicular pain suddenly, ate chocolate bar 2 hours back –

Immediate testicular exploration
U/S
Wait 4h for testicular exploration

77) Level of research after finishing & compare with RCT

78) Insulinoma case scenario – C peptide and insulin levels:

Both increase

79) ABG – COPD scenario

Mixed metabolic alkalosis & respiratory acidosis (high CO₂, high HCO₃)

80) Femoral canal (or hernia) lateral border –

Femoral vein

81) Postop, hypertensive, SOB, tachycardia, ECG with T wave inversion in V3 –

Pulmonary embolism

82) Hernia medial to inferior epigastric artery –

Direct inguinal
Indirect inguinal
Femoral
Obturator

83) 56 year old in ICU after aortic aneurysm repair, pulmonary wedge pressure 20, diffuse opacities in Xray –

Pulmonary edema secondary to heart failure
Pulmonary embolus
Lobar pneumonia
Aspiration pneumonia
ARDS

84) Most susceptible structure to damage during tibial saw in total knee arthroplasty –

Popliteal artery

85) Cardiac patient, unfit, IHD, bilateral common iliac artery block; preferred surgery –

Axillo-bifemoral bypass
Femoro-femoral bypass
Aorto-bifemoral bypass

86) What is seen in anterior surface of heart –

Right ventricle with Pulmonary trunk & infundibulum
Left ventricle with aorta

87) Supply to which vessel makes person left heart dominant –

PDA (posterior interventricular artery)
Circumflex
R coronary
SA node
AV node

88) Esophageal carcinoma compression anteriorly level T3. Structure compressed –

Trachea
Left atrium

89) C6 spine injury (neurogenic shock), now in ICU. Clinical parameters (Capillary pressure, HR, BP, SVR) –

Everything low

90) Chest stab, JVP increased, no trachea deviation, lungs clear

Hemopericardium (cardiac tamponade)

91) Thoracic duct diaphragmatic opening –

T12

92) 11 year old with pruritus ani & scotch tape shows eggs. Causative organism –

Enterobius vermicularis

93) Lumbar puncture surface mark

Iliac crest
Anterior inferior iliac spine
Posterior inferior iliac spine

94) Foot drop, dorsiflexion & anterior tibial artery affected, muscle involved

Tibialis anterior

95) Child burn anterior abdominal wall & thigh. First step on management to minimise burn damage

Rinse area
iv fluids
100% O₂
non-adhesive dressing

96) Pterygopalatine ganglion pathway nucleus

Inferior salivatory
Superior salivatory

97) Spared from facial nerve injury after geniculate ganglion

Lacrimation

98) Burn calculation 20%, 65kg.

1.3L in 8h

99) 75yo active patient. Subcapital #. Treatment

Cemented hemiarthroplasty
Cemented THR

100) 2yo vomits, abdominal distention, passed mucus plug, palpable R bowel loops

Hirschsprung
Meconium ileus

101) Patient loss sensation to lateral forearm & supination, weak grip, can’t hold suitcase

Lateral cord injury
Medial cord injury
Posterior cord injury

102) Patient postop femoral bypass graft on Aspirin & Clopidogrel 75mg until one day before surgery. 3 days after oozing from wound. Normal platelet count.

DIC
Heparin induced thrombocytopenia
Platelet dysfunction

103) Child 12yo obese, hip pain extends to knee

SCFE

104) 6yo child hip pain

Perthes

105) Painful supination and pronation after 3 months, had casting distal radial # for 6 weeks

Malunion
Non-union
Complex regional pain

106) Meckels contains heterotopic pancreatic mucosa. Histology

Basophil acini cells & duct
Mucoid acini cell
Mucoserous acini
beta cells islets of Langerhans
All islets of Langerhans

107) Meckel’s blood supply

Ileocolic
SMA
Middle colic

108) Gallstones, hereditary spherocytosis, hepatomegaly, raised ALP

Bile pigment

109) RTA, hypotensive, small intestine haematoma, free fluid

Laparotomy

110) Girl supracondular humeral #, after 8h severe pain, compartment syndrome. Initial step

Analgesia
Fasciotomy
Loosen slab

111) Stab posterior thigh, sciatic nerve injury. Movement affected

Knee flexion

112) Lymph node drainage from cervix rather than internal iliac

External iliac & presacral

113) Cleft palate embryology

1^st arch
2^st arch

114) Thyroglossal cyst origin

Thyroglossal duct

115) Lady L anterior triangle neck mass moves with swallowing. Investigation

FNAC & U/S

116) Thyroid swelling with FNAC showing nuclear inclusions and clearings

Papillary thyroid ca

117) Thyroid swelling & biopsy with epithelial cells, immunoblasts and mature lymphocytes

Hashimoto’s
Grave’s
Papillary thyroid ca
Follicular thyroid ca
Medullary thyroid ca

118) True about dural sac

Dural sac ends on S2 in adult

119) Chronic pancreatitis with long term back pain

NSAIDs
Nerve block

120) Meralgia anesthetica. Root value of lateral cutaneous nerve of thigh

Lateral L2/L3
Lateral L2/L3/L4

121) Sterilising modern orthopedic arthroscope

Gluteraldehyde
Ethylene oxide

122) Pelvic trauma, sacroiliac dislocation. Most likely nerve injury that comes through great sciatic foramen, below piriformis.

Nerve to obturator internus
Sciatic n.
Lateral cutaneous n. of thigh

123) Child at the distal thigh, bone forming tumour

Ewing
Osteosarcoma

124) Child penis urethra ventral opening. Management

Hypospadias surgery
Epispadias surgery
Meatoplasty
Circumcision

125) Tranexamic acid acts on

Plasmin inhibition
Prothrombin

126) Oral anticoagulant patient with needle phobia, 5 days postoperative. Anticoagulant choice

Rivaroxaban
Warfarin
Clopidogrel
Aspirin

127) Child bleeding issues, divorced parents, inherited from dad.

Factor VIII deficiency

128) Rectus abdominus retracted during Pfannenstiel incision. Structure below

Transversalis fascia
External oblique
Rectus abdominus
Peritoneum

129) Ureter blood supply not from

Iliolumbar

130) Middle finger dermotome

131) Disc prolapse, loss of ankle jerk. Initial step

Lumbar corset
NSAIDs
Physiotherapy
Steroid injection
Spinal decompression

132) Urinary bladder embryologic origin –

Urogenital sinus

133) 58yo fluctuant swelling recent bite, pyrexia, tachycardia, goiter. ECG fibrillation. Swelling needs drainage. Preop action –

b-blockers + thionamides
b-agonists + thionamides
a-blockers + thionamides
a1-agonists + thionamides
a2-agonists + thionamides

134) Colon cancer with metastasis to lung, only did U/S. Next action

Further investigations
Chemotherapy

135) ERAS protocol

Reduced hospital stay
Early mobilisation

136) Hernia case, what will help reduce mesh infection rate most –

Antiseptic skin preparation
Ultra filtration air system
Shaving before surgery

137) ERAS protocol, what is not included

Preop benzodiazepines
Intraoperative antiemetics

138) Hyperacute rejection immediate after transplant

ABO

139) Renal transplant, after 10 days swelling at graft site

Acute rejection
Renal vein thrombosis

140) Tumour senescence

Telomerase mutation
Oncogenic enhancement

141) Gleason score

4+5

142) Renin acts on

Angiotensinogen
Angiotensin I

143) Mass above hyoid moves on swallowing

Thyroglossal cyst

144) Sensation loss on cheek & face flattening after trauma. Bone damaged

Maxillary
Lacrimal
Zygoma

145) Vascular tone due to

Angiotensin II

146) Cavernous sinus pathology. Not affected

Sensation to lower lip
Sensation to cheek

147) Muscle not involved in TMJ movement (muscles of mastication)

Buccinator
Medial pterygoid
Lateral pterygoid
Masseter
Temporalis

148) Loss of extension, lost sensation to little finger

149) Post-colonoscopy patient had miosis. What drug caused it.

Naloxone
Fentanyl

150) B/l lymphadenopathy, back & body pain, histology with plasma cells

Multiple myeloma

151) Hepatic flexure tumour. Surgery option

Resection anastomosis only
Resection & loop ileostomy
Hartmann’s
Loop colostomy

152) Jaundice 3 months after blood transfusion

Hepatitis C
Hepatitis B
Hepatitis A
Haemolysis of transfused blood
ABO incompatibility

153) Not a risk factor for aortic dissection

DM (Diabetes Mellitus)

154) Furosemide action site

Ascending limb of Henle

155) SGLT-2 present at

PCT (proximal convoluted tubule)

156) Lymph node drainage anal canal below dentate line

Superficial inguinal

157) Undifferentiated thyroid ca. Tumour recurrence suspected, takes T3 supplements. Investigation

TSH
T3
T4
Thyroglobulin
Calcitonin

158) Osteosarcoma metastasizes to

Lungs

159) Diabetes insipidus

Collecting tubules

160) Patient with grease, pale stool. Diagnostic option

Faecal elastase
Faecal calprotectin
Serum transglutaminase

161) Pancreatic autodigestion

Trypsin

162) Lateral angulation

Torn meniscus
MCL (medial collateral ligament) injury

163) TURP operation, patient confused prolonged surgery

Hyponatraemia

164) High output fistula, after ileostomy. Electrolyte imbalance.

Hypokalaemia

165) Oesophagus mucosa lining

Non-keratinising stratified squamous epithelium
Columnar epithelium

166) Non-bleeding varices

Terlipressin & octeotride
Sengstaken-Blakemore tube
Banding
Botulinum
Adrenaline

167) Excessive normal saline infusion

Hyperchloraemic (metabolic) acidosis
Hypochloraemic acidosis
Hyperchloraemic alkalosis

168) Child with tension pneumothorax. Initial management

Needle decompression 2^nd mid-clavicular line
Chest tube 5^th mid-axillary line

169) Nerve emerges from superior part of psoas major.

Iliohypogastric
Ilioinguinal
Genitofemoral
Femoral
Obturator

170) Knee extension & quadriceps contraction carried out by

Golgi tendon
Muscle spindle
Brain stem

171) Nerve pierces external oblique and infront of spermatic cord

Ilioinguinal

172) Flesh mass bleeding with touch

Pyogenic granuloma
Angiofibroma

173) Woman after parotic surgery asymmetrical, dry face, absent forehead wrinkles. Nerve injured

Temporal branch of facial nerve
Zygomatic branch of facial nerve
Ophthalmic
Zygomaticotemporal

174) Man with increased creatinine and low calcium, what is reduced

1,25 Dihydroxycholecalciferol

175) Hypothermia ECG

J wave

176) Bilateral inguinal (groin) swelling, cancer from

Labia minora
Vaginal vault
Uterine fundus
Anal cancer
Vulvar cancer

177) Addisonian crisis

Fluids
100mg Hydrocortisone

178) Patient had CT, develops perioral swelling and hypotension

Anaphylactic reaction
Hypovolaemic shock
Septic shock

179) Relation to plasma of insulin & 5% dextrose, given to diabetic patient

Isosmolar & isotonic
Hyposmolar & isotonic
Hyperosmolar & hypotonic
Hyperosmolar & hypertonic
Hyposmolar & hypotonic

180) Fluid rate for 24 kg child

24ml/h
34ml/h
44ml/h
54ml/h
64ml/h

181) Paralytic ileus. Potassium requirements 70kg patient.

182) Loss of dorsiflexion, eversion & dorsum sensation

CPN (common peroneal nerve)

183) Statistics

Positive predictive value related to prevalence

184) 52yo aortic aneurysm repair, histology showed medial necrosis (cystic wall degeneration)

Atheroma
Connective tissue disorder
Syphilis

185) Smoker & xray with peripheral shadows (ground glass appearance).

Small cell carcinoma
Adenocarcinoma
SCC

186) Dumping syndrome, insulin increased

Hypoglycaemia

187) Microscopy showed pink amorphous material

Amyloidosis

188) Red green congo stain

Amyloidosis

189) LMN injury

Flaccid paralysis

190) Clostridium difficile intestine biopsy

Deep ulceration reaching muscularis propria
Ulcers covered by fibrin & deposits
Granuloma
Ulcers covered by amoeba
By fungi

191) Bilateral lymph nodes

Pancoast tumour
Sarcoidosis
Retrosternal goitre

192) Cushing triad, cause of bradycardia

Baro receptor decrease, Vagal tone decrease
Baro receptor increase, Vagal tone increase
Baro receptor decrease, Vagal tone increase

193) Parotid gland surgery, nerve injury, can’t wear ear rings

Auriculotemporal n.
Greater auricular n.
Marginal mandibular of facial n.
Mandibular branch of trigeminal n.

194) Positive ventilation (IPPV)

Decrease end diastolic volume

195) Friends had party, 2h after all have diarrhoea

Staphylococcus aureus

196) Constipation, morphine

Mu receptors

197) Patient travelling from subsaharian Africa in UK with heamaturia

Bladder SCC

198) Fistula between sigmoid & ileum, 5 year history of diarrhoea, weight loss

Crohn’s
Sigmoid diverticulitis

199) Lung lesion, adipocytes (fat) and cartilage

Chondroma
Hamartoma
Teratoma

200) Paraneoplastic syndrome of lung SCC

Acromegaly & GH
Bone & PTH
Insulin & Hypoglycaemia

201) Haemolytic uraemic syndrome

E. Coli

202) Recurrents UTIs, now renal stones. Microorganism

Proteus

203) Smoker with dorsum ulceration

Buerger’s
Diabetic neuropathy
Intermittent claudication

204) Hypovoleamia & after fluid challenge still oliguric

Urine to plasma osmolarity ratio 1:1
Urine specific gravity 1010
Increased urine nitrate
Urine osmolarity 250
Urine sodium 10

205) Blood out of aorta after one cardiac cycle (cardiac output)

70ml

206) Clostridium perfringens

Gram+ rod

207) 79yo back pain, suspicion of inflamed intervertebral disk, spondylodiscitis. Microorganism

Staph aureus
H. influenza
Strep pneumoniae
Kingella
Streptococci

208) 70yo recovery room, 28% oxygen mask, ph decreased, pCO2 increased. Reduced sensitivity

Adrenergic receptors
Baroreceptors
Central chemoreceptors
J receptors
Lung stretch receptors

209) Femoral artery location

Mid-inguinal point

210) Na/K pump

Primary active transport

211) Pancreatitis patient with carpopedal spasm

Hypocalcaemia

212) Pringle’s maneuver. Where is the injured vessel located

Gastrohepatic ligament
Falciform ligament

213) Indication for renal replacement

K⁺ 6.8

214) Ligament support for uterus after delivery

Transverse cervical ligament
Round ligament
Peritoneum

215) Embryologically not from foregut, that have blood supply from coeliac

Spleen

216) 39yo after burns, vomit, abdominal distention and hiccup

Acute gastric dilatation
Acute intestinal obstruction
C. difficile
Faecal impaction
Sepsis

217) Hodgkin’s lymphoma pathology

Large cells with large (prominent) nuclei

218) Hamartoma

Peutz-Jeghers syndrome

219) Unopposed parasympathetic activity

Detrusor muscle contraction

220) Child with bleeding, abdominal distention, crying, pain in R iliac fossa

Intussusception

221) 9 months child with undescended testis. Next step.

Surgical exploration
hCG
Laparotomy with anesthesia in 3 months

222) Poor man with wound not healing, bruising and ecchymosis. Deficiency of what

Vit C
Vit K

223) Most appropriate regimen for daily sodium requirements

1L 0.9% NS + 1L 4% dextrose 0.18% NS
1L 0.9% NS + 1.5L dextrose 5%
1L Hartmann + 1L NS
1L Hartmann + 1L 5% dextrose

224) Patient with single rib fracture, in pain, all vitals normal

Rib fixation
Admission
Observation
Chest drain
Analgesic and discharge

225) Prostate ca metastasis spread

Vertebral arterial system
Sclerotic leads to decreased trabeculae
Long bones

226) Drug derived from isoprenaline that causes vasodilation, acts on b1

Epinephrine
Norepinephrine
Dobutamine

227) Diplopia with adducted eye. Nerve injury

Trochlear
Abducens
Oculomotor

228) Osteoid forming tumour

Osteosarcoma

229) How to confirm 3^rd degree burn

Loss of pin prick sensation
Black eschars in edges

230) Hypercalcaemia initial management

iv fluids

231) Giant cell arteritis, temporal pain & headaches

Chronic granuloma with macrophages

232) Found after trauma and fractured ribs after 24h. What will increase

CRP
Fibrinogen
Albumin

233) Not true after splenectomy

Low WBCs
Basophilia
Low platelets

234) 20yo, has 2 children, breast lesion 3cm mobile, FNAC benign

Discharge & reassure
Core biopsy
U/S in 3 months

235) Preganglionic sympathetic neurotransmitter

Acetylcholine

236) Patient crushed limb and dark red urine

Myoglobin

237) Testicular cancer and metastasis. Elevated tumour marker

AFP

238) Anal cancer

HPV

239) Patient on amoxycillin, develops hypotension, wheezes, rash

Type 1 hypersensitivity reaction
Type 2 hypersensitivity reaction
Type 3 hypersensitivity reaction
Type 4 hypersensitivity reaction
Drug autoimmunity

240) Anaphylactic reaction post hair dye. What to give

im Adrenaline

241) Patient with IHD and now HR 40, anterior wall MI (NSTEMI)

Bundle of His
SA node

242) Ptosis, enopthalmos, miosis, dry face

Sympathetic trunk injury

243) Pleomorphic cells not invading basal membrane

Dysplasia

244) Ulcer pus discharging sinus from osteomyelitis. Initial change to carcinoma

Metaplasia
Anaplasia
Hyperplasia

245) Pulmonary embolism, patient stable

LMWH
UFH

246) Ureter not related to

Round ligament
Broad ligament

247) MS and dysphagia, what compress oesophagus

L atrium

248) Tricuspid closure

Isovolumetric contraction
Isovolumetric relaxation

249) 45yo patient dense shadows, no microcalcifications

Fibrocystic disease

250) Head injury, confussion, vomiting, Na 125. Management

50ml 3% hypertonic saline
Mannitol
Diuretics
Vasopressor agonist

251) ABG – High output fistula

Uncompensated metabolic acidosis

252) Leg trauma stab lower gluteal, knee bruising, no haemarthrosis, cold, pale, femoral pulse present, popliteal artery and distal pulses absent

Knee dislocation
Supracondular #
Tibial #
Patellar #
Compartment syndrome

253) Aortic bifurcation level

254) Dilated lateral ventricle. Obstructed foramen

Interverticular foramen
Cerebral aqueduct

255) Surgical site infection after emergency appendicectomy. Common microorganism

Staphylococcus aureus
Bacteroides

256) 27yo appendicectomy 3years ago, now elbow pigmentation, gluteal, buttock & severe hypotension, rash & hyperkalaemia, hyponatraemia

ACTH
Adrenal insufficiency

257) Lower border of quandragular space

Teres major
Teres minor
Pectoralis major

258) Locked knee

Meniscus tear

259) After trauma has nasal fluid. Best diagnostic test for CSF

b2 transferrin test

260) Bleeding during lumbar puncture

Vertebral venous plexus
Vertebral artery

261) Patient rheumatoid disease, dysphagia, upper GI endoscopy normal

L atrium hypertrophy

262) Wrist injury, severe claw hand, muscle responsible

3^rd and 4^th lumbrical

263) Patient atrophic gastric mucosa, autoimmune disease, thyroiditis. Peripheral smear

Large & oval
Small & pale

264) Boy RTA, pelvis #, resuscitated, passed 350ml urine, now decreased 10ml in Foley

Hypovolaemic shock

265) Extends hip, origin from lumbar intervertebral disk

Psoas major

266) H. Pylori emergency intubation. Best anesthetic agent

Ketamine

267) Lateral forearm sensation lost, other affected function

Supination

268) Appendicitis pain referral

Thoracic splanchnic nerve

269) Unable to initiate abduction

Suprascapular nerve
Dorsal scapular nerve

270) Lady NOF# fixed with dynamic hip screw, after 8-10 days SOB, SpO₂ 93%, reduced BP

Pulmonary embolism
Fat embolism

271) Pupil dilated

Unopposed sympathetic discharge

272) Upper calf claudication

SFA (superficial femoral artery)

273) Stomach tumour biopsy inconclusive (well circumscribed lesion)

GIST

274) Laparoscopic hernia repair. Mesh posterior relation

Peritoneum

275) Pain relieved by hot compression

A beta modulating C fibers

276) Upper limb motor weakness and speech problem

Middle cerebral artery

277) Disturbed balance, uvula deviation. Location of injury

Medulla

278) Posterior relation of lower pole of kidney

Quadratus lumborum
Erector spinae

279) Patient back pain during resting but improved during walking

Spinal stenosis

280) Kidney mass, smoker, heamaturia

Renal cell carcinoma (RCC)
Adenocarcinoma
Transitional cell carcinoma

281) COPD patient on 30% O₂, high CO₂, unresponsive

Medullary receptors

282) XRAY – pneumothorax

Chest drain at 5^th intercostal space midaxillary

283) Acts on b2 to decrease blood pressure

Dobutamine

284) Left side diaphragmatic hernia embryology

Pleuroperitoneal membrane

285) Late sign of compartment syndrome

Loss of pulse

286) Grave’s patient

Carbimazole

287) Bleed on DRE on finger. Source

Sigmoid artery

288) Local anesthetic blocks

Na channels

289) For GFR calculation why substance (inulin) used

Filtered, secreted, not reabsorbed

290) Breast mass, U/S & examination inconclusive. Next step

Core biopsy

291) Least reliable in hypothermic patient

Pulse oximeter

292) Malignant melanoma completely excised. Management

Discharge & educate about self examination

293) Found in MALT in gut mucosa

IgA

294) Multiple liver lesions, 3year after colon ca resection, T3N1. Appropriate management

Further investigations
Resection
Chemotherapy
Radiotherapy

295) Bronchodilation

Sympathetic

296) Warfarin patient, emergency surgery

PCC & iv Vitamin K
Stop warfarin
FFP

Epomedicine

MRCS Part A, September 2023 – Recalls

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