MRCS PART A – 10 Jan 2017

By Group Members (Dr. Salah Group MRCS A DISC)

1. Creamy breast discharge-ectasia

2. skin tethering-pagets, carcinoma
3. blood stained discharged-papilloma
4. boy hit on side of head , squamous part of temporal bone fractured, extradural haematoma
formed-middle meningeal artery
5. old alcoholic drowsy or loss of consciousness, no hx of trauma, then collapses, then dies.- acute
subdural?
6. Preterm baby drowsy, floppy,features of interventricular hmrhge- interventricular hemorrhage
7. Fracture femur + PE signs + brain signs--- brain bilateral petechial hemorrhages
8. Hearing loss tinnitus, + some other signs, external + middle ear were normal- acoustic neuroma
schawanoma?? Cant remember options
9. Small ulcer on tip of nose, a lesion was excised from ear few months ago- options included BCC
SCC, keratoacanthoma, Herpes labialis, metastatic,
10. Ulcer painless on lower lip no cervical LNs enlarged - same options as above
11. Some groin mass, when examined some growth found under big toe nail + discoloration-
12. Malignant melanoma question what is good prognostic factor- 0.5 mm thickness?
13. Pain + swelling rt thigh + external rotation of foot- anterior dislocation of hip, posterior
dislocation of hip, intracapsular neck of femur fracture, shaft of femur fracture
14. Internal rotation of foot- options as above
15. Posterior dislocation of hip +loss of all lower leg muscle what will also be absent- knee flexion,
knee extension
16. Hit on knee+ immediate swelling + haemarthrosis+ aspiration done few days or months later
still pain- acl
17. Anterior drawer sign positive- acl
18. Hx of twisted knee ithink, Unable to full extend knee- medial meniscus injury??
19. Calf pain artery involved- superficial femoral
20. Pelvis surgery, doin something on lateral pelvic wall, groing discomfort + patch on medial side of
thigh numb- obturator
21. Boy on bicycle, presents to mother with with severe pain scrotum, left testes normal sight not
felt what to do- immediate exploration
22. Lower anal canal lymphatics- superficial inguinal
23. Cervix lymphatics- internal iliac
24. Ovaries lymphatics- paraaortic
25. Gut rotation around which structure- coeliac axis, sma, ima, portal vein
26. Uncinate process question structure passing don’t know exactly.
27. Ant to Head of pancreas structure- pylorus, portal vein , hepatic artery, common bile duct
28. Calot’s triangle medial boundary- hepatic artery, cystic duct ,cbd, hepatic duct
29. Post. Duodenal perforation artery involved- gastroduodenal, gastroepiploic
30. Congenital diaphragmatic hernia intestine in chest baby dies, structure develops from- left
pleuroperitoneal membrane, right pleuroperitoneal membrane, septum transversum
31. Flail chest, no pneumothorax but pain on inspiration- l/a 2% lignocaine, 1% or 0.5 bupivacaine,
chest drain,
32. Hx of trauma Raised JVP, trachea shifted to right no breath sounds on left, what to do- chest
drain to anterior left side, chest drain to posterior right side, ETT.
33. Incision from deltopectoral groove medially, which structure will not be interfered- axillary ln,
brachial plexus, pec major, pec minor
34. Which structure is not posterior relation of kidney- iliacus, psoas, ql, tranversalis, diaphragm
35. Rectal bleeding, on colonscopy found bleeding from sigmoid colon, artery- superior rectal, left
colic, middle colic
36. Neonate, meconium stained front of diaper- patent urachus, patent vitellointestinal duct
37. Sausage shaped- intusucception
38. Boy, Cherry red mass protruding from anus, bleeding – hemorrhoid, juvenile polyp
39. Baby, Abd pain, bilious vomiting- volvulous or other options as above
40. Panproctocolectomy stoma-end ileostomy, end colostomy in LIF, loop ileostomy, loop
colostomy
41. Hartmann’s procedure stoma- end ileostomy, end colostomy in LIF, loop ileostomy, loop
colostomy
42. Bullet hit lateral to rectus abdominis at right subcostal region, which structure injured-
gallbladder, liver, spleen, kidney
43. Transpyloric plane
44. Manubriosternal angle level structure- arch meets descending aorta
45. Esophagus pierced in cm- 22, 27, 38, 40, 15
46. Aortic opening- t12
47. Fluid- 2l glucose + 1l n.s, 0.18 ns+ 5% dextrose, 3 l n/s , 3l glucose
48. Fluid resuscitation best initially- normal saline.
49. Prostate cancer questions x 2 one with obstructive urinary features, backache- watchful waiting,
surgery, turp, hormonal therapy
50. 2nd prostate question?
51. Consent- less than 16 years old, down syndrome patient , can understand appendicitis
procedure and risks- consent the patient, consent the parents, by proxy, court , proceed without
consent
52. Consent- trauma, emergency, intraabdominal bleeding- proceed without consent
53. Consent- 4 years old, requires blood transfusion , hb deteriorating, parents donot consent due
to religious reasons- consent the patient, consent the parents, by proxy, court jury , proceed
without consent
54. Statistics- paired t test, chi square test
55. Fall on outstretched hand, no fracture but carpal tunnel syndrome features- scaphoid
dislocation, lunate dislocation
56. Shinny tense palm skin + fracture hx?- regional pain syndrome, other options doesnt remember
a.
57. Starling forces.. calculate filtration pressure bowmen capsule hydrostatic pressure =33 – outside
hydrostatic pressure 15 – ( bowmans oncotic 10 – outside oncotic 0) = +8
58. Baroreceptor venoconstriction first response
59. PE- t wave inversion v1-v3
60. Sternum fracture, what structure will be damaged.. – RA, RV, esophagus
61. GCS x 2 question.
62. 5% burn on torso full thickness- full thickness graft, split skin, fasciotomy
63. Arm in boiling water, full arm superficial burns, blistering- keep open, occlusive dressing
64. Pt abduction and adduction lost root involved- t1
65. Dupytrens contracture tm- release trigger finger
66. Mortons neuroma- neurons fibrosis, synovium
67. Head injury long term feeding reuired- gastrostomy
68. Crohns patient feeding
69. Regional pain syndrome in options
70. Pulp infection block- ring block
71. Radius dislocation heart issues
72. Urine output 80 80 0 0 (hrly)—blocked catheter
73. Mycotic aneurysm- streptococcus, candida, aspergillus
74. Thyroid mass, pulsating mass on forehead- follicular ca
75. Rapidly spreading, stridor- anaplastic
76. Within 3hr presentation – femoral embolectomy
77. Dusky leg
78. Femorodistal bypass done 1 yr back, now distal pulses absent but limb movement present
79. Aortic aneurysm 4.5 cm—ct or us
80. MRSA – patient was mrsa carrier going for surgery tm- oral vanc bd, teicoplanin iv, mupirocin
i/n, rifampicin +
81. Cvp line infection, other patients were mrsa carrier. tm
82. Esophageal ca + mediastinal mets—stent
83. Bone mets pain tm- radio
84. Gastric fundus ca. lymphatics- celiac, paraaortic
85. Pt with abdominal pain, Ca 3.7- Iv fluids or bisphosphonates
86. Ulcer on medial malleolus-
87. Pancoast tumor-t1
88. Neurosurgery bleeding posteriorly- occipital a
89. Cuboid bone anteriorly which bones are present- 4th 5th metatarsals
90. Medial side of leg numb- sephanous n
91. A treatment was started by hospital doctors, but family doctor did not continue with that
treatment.. audt question.
92. Plaster cast leg… CPL
93. Loss of foot eversion + foot dorp- common peroneal component of sciatic nerve
94. Axillary nerve supply deltoid +…. Teres minor
95. On colonoscopy lots of polyps..type?
96. 10 yrs old bloody diarrhea---IBD
97. Colonic resection done, liver mets asymptomatic
98. Paeds age swallowed coin where it stuck.- at t4, cricoid, tyroid prominence
99. Which level of spine compression least likely to cause spastic paralysis?
100. Appendix pain started at paraumblical region….dermatome…. t10
101. Lower lip numb + muscle of mastication not working—mandibular nerve
 102. Mandibular nerve foramen---ovale
103. Middle meningeal artery foramen—spinosum
104. Nystagmus, ataxia….PICA?
105. Lower limb paralysis artery territory—aca
106. Head injury gcs 15, then gcs drop and one side blown pupil???—transtentorial
herniation, hydrocephalus,
107. Sympathetics at spinal cord..—lateral horn
108. Hypercalcemia with renal stone.. Solitary parathyroid adenoma or diffuae parathyroid
hyperplasia?

EMq. acid base: what acid base equation..match with the below scenarios

109. a pt with recurrent gastric pain.. Presented with gatric outlet obstruction .
110. A pt with pyrolus stenosis
111. A pt with malignant came with lethargy vomiting

-----

112. Claundication bt improve with uphill.. Lumbar stenosis?

113. Multiple myeloma test.. protein electrophoresis
114. Spine extension pain.. Facet arthrosis?
115. Cushings triad
116. Septic shock--- dec svr inc hr inc CO?
117. A pt with hypovolenia symptoms.. Given options: decreased extracellular, increased
interstitial.. increase intracellular?
118. A pt with tension pneunothorax symptoms.. What compromised his
cardiopulnonary status .. Decreased venous return n caused decreased cardiac output?
Emq :
119. 1. Inr deranged .. Came for bleeding haemorrhnoid underlying liver problem . Vit k?
120. 2. Urgent op for perforation.. Inr deranged.on warfarin.
121. 3. Aortic leaking for op.. Bp lowish.. 2 negative blood?
Wound emq:
122. 1. Post colectomy.. Heel prrssure sore with skin necrosis
123. 2. Blust injury wound
124. 3. Leg burn with deep wound. 3 weeks later with ulcer 7x10 ..tibia exposed
125. Cn IX X XII origin….. Pons or medulla
126. Lytic lesions femoral fracture, where does the primary came from… breast?
127. Axillary dissection done, patient when tries to pick up knife unable to do so because
wrist flexes. – medial cord, posterior cord, median, ulnar, radial
128. Smoking Hx, + shistosoma haematobium Hx…. SCC or TCC bladder
129. Lateral horn of spinal cord…. Sympathetics
130. Patient has loin pain haematuria smoker Hb 113 g/l
131. Femoral canal lateral relation- femoral vein
132. Inguinal canal posterior wall—conjoint tendon
133. External inguinal ring is a defect in…. EOA
134. Hydrocele is surrounded by which scrotal covering-- T.V
135. Boy on bicycle severe pain in scrotum, on exam left testis palpable left not, what to do
next……Exploration
136. Trendelenberg gait muscle- Glut medius
137. Aortic opening level- 12
138. Insulin dependent glucose transporter 2 work where on kidney- PCT
139. Aldosterone action ---- Na Cl in DCT or Na K in CD
140. Renal vein relation—ant to aorta
141. Posterior duodenal ulceration artery—gastroduodenal
142. Recurrent duodenal ulcer ppi used, what will be inc in blood---gastrin
143. Gastric acidity is inc by—vagus+histamine+gastrin
144. Achalasia question??
145. Amylase inc, serum Ca 3.7 --- hyperparathyroidism (sheet fawzia question)
146. Renal transplant few years ago,PO4 is low, Ca2+ is high PTH high---tertiary HyperPTH
147. Wound healing 7th day---angiogenesis
148. Mediastinal masses plus cervical LN biopsy . characteristics—reedsternberg or mitotic
cells
149. Polyps hx plus oral lesion (peutz jeghr)..characteristics of polyps...
150. Another q from sheet.. hamartoma characteristics were given..
151. Nodule on extensor surface on elbow.....
152. That was another... hassal corpuscle..thymoma
153. Congenital diphragmatic hernia Neonate dies... embryo... right or left pleuroperitoneal
membrane defect?
154. Muscles of facial expression from which paryngeal arch.....2nd arch
155. Patient car accident... she was wearing seatbelt plus mediastinal widening... aortic
disection
156. Parietal pleura nerve supply....intercostals?
157. SA node nerve comes from.....fibers from vagus
158. Breast CA with metastis but general Ms weakness and hypotonia?
159. Hypovolemic shock decreased in extracellular fluid?
160. case post colectomy.. Heel skin necrosis--- conservative mngment?
161. Thyroid ca with invasion to trachea...anaplastic
162. F.B. stuck in child...cricoid
163. A pt alleged hot water splashed over dorsal forearm.. Got blister swollen n sensitive.
Wats the answer? Given option fasciotomy, eschratomy
164. There was a bilirubin question...pale stool dark urine..
165. Fracture sternum..structure injured immediately... That was rt atrium?Rt ventricle
166. Post renal transplant pneumonia- CMV I think???
167. Mycotic aneurysm bacteria?
168. Lymphodema pt with cellulitis after insect bite
169. Single rectal polyp in 35 man...fibroepithelial??
170. Best investigation for diverticular disease with colovesical fistula..CT
171. There was mixed respiratory and metabolic acidosis scenario rt?
172. And one compensated scenerio too. Although ph was 7.38
173. Ca with met.. Vomiting lethargy
174. FEV1/FVC > 80 restrictive picture- options, Pulmonary fibrosis, bronchiectasis, copd,
asthma
175. Posterior relations of kidney.. Iliacus not one
176. Pulmonary arteries development ...6th arch
177. Vertebral artery of subclavian
178. Resuscitation question.. 2l of glucose+ 1 L of 0.9 saline or the reverse.. 2saline+
1glucose?
179. Pneumobila question?? That was doudenum rt? First time to see the term.
180. Bronchial CA in periphery...that was?Adenocarcinoma
181. Charot triad..cholangitis.. Question
182. Skin lesion one answer was dermatofibroma
183. Prophylaxis for spleenectomy?
184. Liver failure 2,7,9,10
185. Emergency mini tracheostomy... Thyrocricoid membrane or cricoid membrane
186. One side soft palate n tongue reduced sensation. Which part of brain got compressed-
Medulla or pons?
187. Saccular aneurysm .. What cause it?
188. Hpe shows hyperchromatic nuclei..failed maturation
189. Numbness at chin...mental Nerve?
190. A pt undergone ovarian surgery.. Post op numbness groin n mid thigh
191. Groin mass.. Swelling under big toe bed with deformed toe... Malignant melanoma?
192. Respiratory receptors sensitivity cannot remember the scenario.
193. Extensor pollices Longus rupture question...same Hasnain discussed the night be fore
exam .👏
194. Modern sterilization for arthroscope--Ethanol oxide or Glutraldehydes
195. Post cabg.. Sternal wound with some discharge Serosanguinous fluid... options? vanco n
genta, other options?
196. A man with gyneocomastia-phyological or pituitary adenoma
197. A pt with low Na.. No hypotensive...urine ouput >3++ siadh?
198. Traumatic eye with normal xray?
199. Post travel with femoral extensive mobile thrombus?
200. Paratid surgery.. Injured facial nerve
201. One of it was pituitary adenoma
202. Ca 3.7... hyperparathyroid
203. Septic shock.... arrows...
204. Doc for anaphylactic shk
205. Otitis media effusion , deep cervical lymph node.. Cant remember scenalio
206. Best investigation in PE
207. Chrons scenario one was most of small intestine resected,,,,TPN
208. Other emq only 30cm was resected,, elimentry feeding
209. A pt got burn.. Some 3weeks later got ulcer exposing tibia.. Wats the answer?
210. Split thickness?
211. Amount of blood in Aorta per cardiac cycle??70ml
212. I put wound debridement and delayed primary closure
213. What is true about left coronary artery?-- Passes behind pulnonary trunk
214. Siadh with euvolemia.. Wats the answer? Water deprivation??
215. Gunshot passed ant to post lat to right rectus Subcostal margin. --gallbladder
216. Regarding mortons neuroma.-perineural fibrosis, spindle fibers sth fibrosis.. Cant really
remember