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MRCS Part A, September 2023 – Recalls

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

2) Neck stab, tongue deviation –

3) Chest XRAY scenario – foreign body –

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

5) Reciprocal of absolute risk reduction –

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

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

8) XRAY scenario – patient with hysterectomy scar –

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

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

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

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

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

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

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

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

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

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

19) Xray barium swallow scenario –

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

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

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

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

24) Most reliable score for preoperative mortality –

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

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

27) Goal directed treatment –

28) Audit – retrospective evaluation against a set standard –

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

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

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

32) Inferior pole relation of Lt. adrenal gland –

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

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

35) Froment’s test; muscle tested –

36) Primary action of cortisol in postoperative period –

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

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

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

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

41) Level of artery that provides superior rectum blood supply

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

43) Osgood-Schlatter disease

44) Areflexia –

45) Rt testicular vein drains to –

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

47) Child with upper interventricular defect. Originated from –

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 –

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 –

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

53) What is riskier for surgical patients –

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

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

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

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

58) Line of Zahn on autopsy seen in –

59) Submandibular gland surgery. Bleeding most likely from –

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

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

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

63) Retractile testis scenario. Structure responsible –

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

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

66) Breast eczema. Paget association –

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

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

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

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

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

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

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

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

75) Patient with unilateral gynecomastia. Check for –

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

77) Level of research after finishing & compare with RCT

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

79) ABG – COPD scenario

80) Femoral canal (or hernia) lateral border –

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

82) Hernia medial to inferior epigastric artery –

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

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

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

86) What is seen in anterior surface of heart –

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

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

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

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

91) Thoracic duct diaphragmatic opening –

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

93) Lumbar puncture surface mark

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

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

96) Pterygopalatine ganglion pathway nucleus

97) Spared from facial nerve injury after geniculate ganglion

98) Burn calculation 20%, 65kg.

99) 75yo active patient. Subcapital #. Treatment

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

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

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

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

104) 6yo child hip pain

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

106) Meckels contains heterotopic pancreatic mucosa. Histology

107) Meckel’s blood supply

108) Gallstones, hereditary spherocytosis, hepatomegaly, raised ALP

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

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

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

112) Lymph node drainage from cervix rather than internal iliac

113) Cleft palate embryology

114) Thyroglossal cyst origin

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

116) Thyroid swelling with FNAC showing nuclear inclusions and clearings

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

118) True about dural sac

119) Chronic pancreatitis with long term back pain

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

121) Sterilising modern orthopedic arthroscope

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

123) Child at the distal thigh, bone forming tumour

124) Child penis urethra ventral opening. Management

125) Tranexamic acid acts on

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

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

128) Rectus abdominus retracted during Pfannenstiel incision. Structure below

129) Ureter blood supply not from

130) Middle finger dermotome

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

132) Urinary bladder embryologic origin –

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

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

135) ERAS protocol

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

137) ERAS protocol, what is not included

138) Hyperacute rejection immediate after transplant

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

140) Tumour senescence

141) Gleason score

142) Renin acts on

143) Mass above hyoid moves on swallowing

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

145) Vascular tone due to

146) Cavernous sinus pathology. Not affected

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

148) Loss of extension, lost sensation to little finger

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

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

151) Hepatic flexure tumour. Surgery option

152) Jaundice 3 months after blood transfusion

153) Not a risk factor for aortic dissection

154) Furosemide action site

155) SGLT-2 present at

156) Lymph node drainage anal canal below dentate line 

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

158) Osteosarcoma metastasizes to

159) Diabetes insipidus

160) Patient with grease, pale stool. Diagnostic option

161) Pancreatic autodigestion

162) Lateral angulation

163) TURP operation, patient confused prolonged surgery

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

165) Oesophagus mucosa lining

166) Non-bleeding varices

167) Excessive normal saline infusion

168) Child with tension pneumothorax. Initial management

169) Nerve emerges from superior part of psoas major.

170) Knee extension & quadriceps contraction carried out by

171) Nerve pierces external oblique and infront of spermatic cord

172) Flesh mass bleeding with touch

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

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

175) Hypothermia ECG

176) Bilateral inguinal (groin) swelling, cancer from

177) Addisonian crisis

178) Patient had CT, develops perioral swelling and hypotension

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

180) Fluid rate for 24 kg child

181) Paralytic ileus. Potassium requirements 70kg patient.

182) Loss of dorsiflexion, eversion & dorsum sensation

183) Statistics

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

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

186) Dumping syndrome, insulin increased

187) Microscopy showed pink amorphous material

188) Red green congo stain

189) LMN injury

190) Clostridium difficile intestine biopsy

191) Bilateral lymph nodes

192) Cushing triad, cause of bradycardia

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

194) Positive ventilation (IPPV)

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

196) Constipation, morphine

197) Patient travelling from subsaharian Africa in UK with heamaturia

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

199) Lung lesion, adipocytes (fat) and cartilage

200) Paraneoplastic syndrome of lung SCC

201) Haemolytic uraemic syndrome

202) Recurrents UTIs, now renal stones. Microorganism

203) Smoker with dorsum ulceration

204) Hypovoleamia & after fluid challenge still oliguric

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

206) Clostridium perfringens

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

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

209) Femoral artery location

210) Na/K pump

211) Pancreatitis patient with carpopedal spasm

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

213) Indication for renal replacement

214) Ligament support for uterus after delivery

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

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

217) Hodgkin’s lymphoma pathology

218) Hamartoma

219) Unopposed parasympathetic activity

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

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

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

223) Most appropriate regimen for daily sodium requirements

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

225) Prostate ca metastasis spread

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

227) Diplopia with adducted eye. Nerve injury

228) Osteoid forming tumour

229) How to confirm 3rd degree burn

230) Hypercalcaemia initial management

231) Giant cell arteritis, temporal pain & headaches

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

233) Not true after splenectomy

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

235) Preganglionic sympathetic neurotransmitter

236) Patient crushed limb and dark red urine

237) Testicular cancer and metastasis. Elevated tumour marker

238) Anal cancer

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

240) Anaphylactic reaction post hair dye. What to give

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

242) Ptosis, enopthalmos, miosis, dry face

243) Pleomorphic cells not invading basal membrane

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

245) Pulmonary embolism, patient stable

246) Ureter not related to

247) MS and dysphagia, what compress oesophagus

248) Tricuspid closure

249) 45yo patient dense shadows, no microcalcifications

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

251) ABG – High output fistula

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

253) Aortic bifurcation level

254) Dilated lateral ventricle. Obstructed foramen

255) Surgical site infection after emergency appendicectomy. Common microorganism

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

257) Lower border of quandragular space

258) Locked knee

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

260) Bleeding during lumbar puncture

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

262) Wrist injury, severe claw hand, muscle responsible

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

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

265) Extends hip, origin from lumbar intervertebral disk

266) H. Pylori emergency intubation. Best anesthetic agent

267) Lateral forearm sensation lost, other affected function

268) Appendicitis pain referral

269) Unable to initiate abduction

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

271) Pupil dilated

272) Upper calf claudication

273) Stomach tumour biopsy inconclusive (well circumscribed lesion)

274) Laparoscopic hernia repair. Mesh posterior relation

275) Pain relieved by hot compression

276) Upper limb motor weakness and speech problem

277) Disturbed balance, uvula deviation. Location of injury

278) Posterior relation of lower pole of kidney

279) Patient back pain during resting but improved during walking 

280) Kidney mass, smoker, heamaturia

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

282) XRAY – pneumothorax

283) Acts on b2 to decrease blood pressure

284) Left side diaphragmatic hernia embryology

285) Late sign of compartment syndrome

286) Grave’s patient

287) Bleed on DRE on finger. Source

288) Local anesthetic blocks

289) For GFR calculation why substance (inulin) used

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

291) Least reliable in hypothermic patient

292) Malignant melanoma completely excised. Management

293) Found in MALT in gut mucosa

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

295) Bronchodilation

296) Warfarin patient, emergency surgery

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