MRCS Part A:

Paper 1 SBAs in
Applied Basic Science
Second Edition
Shahzad G Raja
BSc, MBBS, MRCS, FRCS(CTh)
Specialist Registrar in Cardiothoracic Surgery
Department of Paediatric Cardiothoracic Surgery
Great Ormond Street Hospital
London

Introduction
This revised and updated second edition of Intercollegiate MRCS: 300
Single Best Answer Questions in Applied Basic Sciences not only has a new
title but also includes 60 new questions that conform to the current
IMRCS examination format. The revised edition has been updated to
remain current with the syllabus and with the subtle changes in the
examination philosophy.
There are many single best answer guides available for the IMRCS
candidates. However, MRCS Part A Paper 1: Single Best Answer Questions in
Applied Basic Sciences is the only title that provides real-type practice
questions at the appropriate level for candidates, similar to the exam.
The 360 questions in this book are divided into three major sections,
namely Anatomy, Physiology, and Pathology; each section has 120
questions with answers and detailed teaching notes. The questions in
the book are designed to enable candidates to master large amounts
of information in a limited amount of time as well as review important
topics quickly and easily. There is a natural tendency to avoid the
harder and more confusing topics, but rather than avoiding these,
I have deliberately included them so that the candidates can use
these to their advantage; everyone will get the easy questions right,
but the students who enter the examination having done the more
difficult questions should not just pass, but pass well.
I am hopeful that this revised edition will prove more useful for the
IMRCS candidates as it has been prepared in direct response to the
feedback from the candidates who have sat the IMRCS examination. It
is expected that I will be guided by constructive criticism and useful
suggestions in the future as well. Last but not the least, I take this
opportunity to acknowledge the numerous sources and resources
which have been used in the preparation of this revised edition.
Shahzad G Raja

anatomy

Section 1:
Anatomy Questions
For each question given below choose the SINGLE BEST option.

1.1

Following tonsillectomy, a patient noted loss of

general sensation and taste from the posterior
one-third of the tongue. It could be assumed that
the nerve that was injured was a branch of the:

m
m
m
m
m

Facial nerve

Glossopharyngeal nerve

Hypoglossal nerve

Lingual nerve

Vagus nerve

1.2

Which one of the following arteries can be felt

pulsating at the lower border of the mandible just
anterior to the masseter muscle?

m
m
m
m
m

Facial artery

Lingual artery

Maxillary artery

Superficial temporal artery

Transverse facial artery

MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Edition

anatomy

1.3

Which one of the following structures lies parallel

and immediately deep to the carotid sheath in the
neck?

m
m
m
m
m

Internal jugular vein

Superior ramus of the ansa cervicalis

Sympathetic trunk

Trachea

Vagus nerve

1.4

While mobilising the second part of the duodenum

a vital structure got injured. Which one of the
following structures is it most likely to be?

m
m
m
m
m

Gallbladder

Hilum of the right kidney

Left lobe of the liver

Superior mesenteric artery

Transverse colon

1.5

Injury to which one of the following nerves will

result in an inability to dorsiflex and evert the
foot?

m
m
m
m
m

Common peroneal nerve

Deep peroneal nerve

Femoral nerve

Superficial peroneal nerve

Tibial nerve

Questions

Which one of the following is the most superficial

structure encountered while performing dissection
in the popliteal fossa?

m
m
m
m
m

Popliteal artery

Popliteal vein

Posterior tibial artery

Profunda femoris artery

Tibial nerve

1.7

A 43-year-old woman was diagnosed as having

a meningioma that was compressing the neural
contents within the right jugular foramen. Which
one of the following clinical features is most likely
to be seen in this patient?

m
m
m
m
m

Inability to elevate soft palate

Inability to protrude tongue

Inability to turn chin upwards and to the left

Loss of pain from the anterior two-thirds of the tongue

Sensory loss from skin overlying the zygomatic bone

1.8

A 56-year-old man was found to have enlarged

submental lymph nodes. Enlargement of the
submental lymph nodes is suggestive of pathology
of which one of the following structures?

m
m
m
m
m

Hard palate

Maxillary incisors

Palatine tonsils

Soft palate

Tip of the tongue

anatomy

1.6

MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Edition

anatomy

1.9

A 26-year-old motorcyclist was brought to the

Emergency Department with a fractured right
humeral shaft. Which one of the following nerves
is most likely to be injured in a fracture of the
humeral shaft?

m
m
m
m
m

Axillary nerve

Median nerve

Musculocutaneous nerve

Radial nerve

Ulnar nerve

1.10

A 36-year-old builder falls from the ladder

resulting in the entire greater tubercle of the
left humerus being torn away. Which one of the
following movements of the humerus would be
affected as a result of this injury?

m
m
m
m
m

Abduction and lateral rotation

Extension and medial rotation

Flexion and medial rotation

Flexion, abduction and adduction

Flexion and abduction

1.11

Clinical examination of a 56-year-old man reveals

absent vibratory sensation in the toes. Absent
vibratory sensation in the toes may indicate a
lesion in the:

m
m
m
m
m

Anterior nerve roots

Anterior spinothalamic tract

Lateral columns of the spinal cord

Posterior white columns of the spinal cord

Spinotectal tract

1.12

A 67-year-old patient with atrial fibrillation has an

embolic stroke. A computed tomography (CT) scan
reveals extensive infarction of the medial surface
of the frontal, parietal and limbic lobes. Embolic
occlusion of which one of the following arteries
will affect the blood supply to the medial surface
of the frontal, parietal and limbic lobes?

m
m
m
m
m

Anterior cerebral artery

Anterior choroidal artery

Anterior communicating artery

Middle cerebral artery

Posterior cerebral artery

1.13

Which one of the following structures is most

likely to be damaged if a lesion in the caudal
medulla resulted in ipsilateral loss of perception of
pain over much of the face?

m
m
m
m
m

Dorsal trigeminothalamic tract

Lateral spinothalamic tract

Medial lemniscus

Spinal trigeminal tract

Ventral trigeminothalamic tract

1.14

Which one of the following pairs of nerves supplies

the biceps femoris muscle?

m
m
m
m
m

Femoral and common peroneal nerves

Femoral and obturator nerves

Obturator and tibial nerves

Tibial and common peroneal nerves

Tibial and femoral nerves

anatomy

Questions

MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Edition

anatomy

1.15

Patients with myocardial infarction usually

experience excruciating pain running down the left
upper extremity. This referred pain is relayed by
the:

m
m
m
m
m

Left intercostobrachial nerve

Left musculocutaneous nerve

Left phrenic nerve

Left recurrent laryngeal nerve

Left vagus nerve

1.16

Which one of the following structures forms the

lateral boundary of the superior mediastinum?

m
m
m
m
m

Lateral border of the sternum

Mediastinal pleura

Roots of the lungs

Sternal angle

T1T4 vertebrae

1.17

Which one of the following parts of the heart

will be damaged as a result of occlusion of the
circumflex branch of the left coronary artery?

m
m
m
m
m

Apex of the heart

Left atrium and left ventricle

Left ventricle and interventricular septum

Right atrium and left ventricle

Right and left ventricles

Questions

An FY doctor, while performing a posterolateral

thoracotomy injures the posterior intercostal
artery in the fifth intercostal space on the left
side. The posterior intercostal artery in the fifth
intercostal space arises from the:

m
m
m
m
m

Costocervical trunk

Internal thoracic artery

Musculophrenic artery

Subclavian artery

Thoracic aorta

1.19

The site of the cloacal membrane (which is also

the point of demarcation between the endodermal
and ectodermal epithelium) is represented in the
adult anal canal by the:

m
m
m
m
m

Anal valves (pectinate/denate line)

External anal sphincter

Rectal columns

Transition zone

White line

anatomy

1.18

1.20 A newborn baby is diagnosed as having a vitelline

duct anomaly. Which one of the following is a
vitelline duct anomaly?

m
m
m
m
m

Duodenal stenosis

Gastroschisis

Omphalocele

Umbilical fistula

Umbilical hernia

2.19 A 38-year-old man undergoes lung volume studies

using the helium dilution method. The test begins
at the end of a normal expiration. The initial
fraction of helium in the spirometer is 0.05, and
the helium fraction after equilibration with the
lungs is 0.03. The volume of gas in the spirometer
is kept constant at 4 L during the procedure by
the addition of O2. According to a spirogram, this
patients vital capacity is 5 L and his expiratory
reserve volume is 2 L. What is this patients
functional residual capacity?

m
m
m
m
m

1.0 L

1.7 L

2.7 L

3.0 L

5.0 L

2.20 A 38-year-old man undergoes lung volume studies

using the helium dilution method. The test begins
at the end of a normal expiration. The initial
fraction of helium in the spirometer is 0.05, and
the helium fraction after equilibration with the
lungs is 0.03. The volume of gas in the spirometer
is kept constant at 4 L during the procedure by
the addition of O2. According to a spirogram, this
patients vital capacity is 5 L and his expiratory
reserve volume is 2 L. What is this patients residual
volume?

m
m
m
m
m

0.7 L

1.0 L

1.7 L

2.7 L

3.0 L

53

physiology

Questions

MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Edition

2.21 Insulin is produced by the cells of the islets of

Langerhans in the pancreas. Insulin secretion from
endocrine pancreas is inhibited by:

m
m
m
m
m

Glucagon

2-Adrenergic agonists

2-Adrenergic agonists

Cholecystokinin

Muscarinic agonists

physiology

2.22 Vasopressin is released from the posterior

pituitary gland when there is a decrease in plasma:

m
m
m
m
m

Potassium concentration

Sodium concentration

pH

Volume

Calcium concentration

2.23 The second heart sound is produced by the closure

of the aortic and pulmonic valves. Closure of the
aortic valve occurs at the onset of:

m
m
m
m
m

54

The rapid ejection phase of the cardiac cycle

The isovolumetric contraction phase of the cardiac cycle

The protodiastole

The rapid filling phase of the cardiac cycle

The isovolumetric relaxation phase of the cardiac cycle

Questions

2.24 Turbulence in a blood vessel is more likely to occur

if:

m
m
m
m
m

The velocity of blood within the vessel increases

The diameter of the vessel decreases

The viscosity of blood within the vessel increases

The density of blood decreases

The length of the vessel increases

m
m
m
m
m

The arterial PCO2 is increased

The pH is decreased

The blood temperature is increased

The H+ concentration is increased

2,3-Diphosphoglycerate (DPG) levels in the red blood

cells (RBCs) are decreased

physiology

2.25 The affinity of haemoglobin for oxygen will

increase if:

2.26 A patient with persistent diarrhoea will have an

increased:

m
m
m
m
m

Anion gap

Filtered load of bicarbonate

Production of ammonia by the distal tubule

H+ secretion by the distal tubule

Production of new bicarbonate by the proximal tubule

55

MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Edition

2.27 A patient in the Emergency Department with

profuse haemorrhage from a severed limb artery
will have increased:

m
m
m
m
m

Sodium excretion

Sympathetic nerve activity

Vagal nerve activity

Arteriolar diameter in skin

Water excretion

physiology

2.28 Intestinal peristalsis results in the movement of

food through the gut. Intestinal peristalsis:

m
m
m
m
m

Is controlled by extrinsic innervation

Is inhibited by vagotomy

Is inhibited by sympathectomy

Requires an intact myenteric nerve plexus

Is inhibited by cholecystokinin

2.29 Secretin was the first substance that was

identified to cause a physiological effect in the
body after being transported via the blood. Which
of the following statements about secretin is true?

m
m
m

It is a polypeptide hormone made up of 17 amino acids

It increases gallbladder emptying

It is released by the presence of long-chain fatty acids in

the chyme

m
m

It stimulates bicarbonate release from the pancreas

It inhibits pepsinogen secretion

56

Questions

m
m
m
m
m

Increased PCO2

Increased PO2

Decreased alveolar dead space

Decreased right ventricular afterload

Increased pulmonary vascular resistance

2.31

What will be the interstitial osmotic pressure in

a skin capillary if fluid is being forced out of it
with a net filtration pressure of 8 mmHg when
the capillary hydrostatic pressure is 24 mmHg,
interstitial hydrostatic pressure 7 mmHg and
capillary colloid osmotic pressure 17 mmHg?
(Assume that both the filtration coefficient and
reflection coefficient in this case are 1.)

m
m
m
m
m

8 mmHg

6 mmHg

9 mmHg

9 mmHg

6 mmHg

physiology

2.30 A 72-year-old woman developed an acute

pulmonary embolism 3 days after her total hip
replacement. Which of the following features is
most likely to be seen in this patient?

57

MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Edition

2.32 When air enters the intrapleural space

(pneumothorax), the most likely response is for:

physiology

The lung to expand outwards and the chest wall to spring

inwards

The lung to expand outwards and the chest wall to spring

outwards

The lung to collapse inwards and the chest wall to

collapse inwards

The lung to collapse inwards and the chest wall to spring

outwards

The lung volume to be unaffected and chest wall to

spring outwards

2.33 Haemodynamic changes in response to obstruction

of venous return to the right side of heart include:

Cardiac output will fall and systemic arterial blood

pressure will fall

Cardiac output will rise and systemic arterial blood

pressure will rise

Cardiac output will fall and systemic arterial blood

pressure will rise

Cardiac output will fall and systemic arterial blood

pressure will remain unchanged

Cardiac output will remain unchanged and systemic

arterial blood pressure will fall

58

Questions

2.34 Common features of a tumour of the right atrium

and cardiac tamponade include:
A

Pulmonary oedema, pulmonary hypertension and

pulmonary venous congestion

Pulmonary venous congestion, systemic venous

congestion and systemic hypotension

m
m

Systemic oedema, high cardiac output and ascites

Systemic oedema, congestion of the systemic veins and

ascites

Pulmonary oedema, systemic hypertension and low

cardiac output

physiology

2.35 Voltage-gated sodium channels are an example of

a protein embedded in the plasma membrane of
nerve and muscle cells that is used in the rapid
electrical signalling found in these cells. Voltagegated sodium channels:

Are formed by co-assembly of five identical or similar

subunits

Have specialised transmembrane domains (S4) that sense

transmembrane voltage

m
m
m

Are equally permeable to K+ and Na+

Are activated by binding of glycine

Are activated by a decrease in intracellular ATP

concentration

59

MRCS Part A: Paper 1 SBAs in Applied Basic Science, Second Edition

2.36 Cells within the sinoatrial (SA) node are the

primary pacemaker site within the heart.
These cells are characterised as having no true
resting potential, but instead generate regular,
spontaneous action potentials. Phase 0 of an SA
nodal action potential results from:

physiology

m
m
m
m
m

Activation of sodium channels

Activation of the pacemaker current

Influx of Ca2+ ions

Inactivation of K+ channels

Influx of Na+ ions

2.37 What should the myeloid:erythroid ratio in your

bone marrow be if you want to be a voluntary
bone marrow donor?

m
m
m
m
m

1:1

1:3

3:1

1:10

10:1

2.38 Substances with high oil:water partition

coefficients readily permeate cell membranes.
Which group has high oil:water partition
coefficients?

m
m
m
m
m

60

Peptides, steroid hormones, oxygen

Steroid hormones, oxygen, ions

Oxygen, ions, carbon dioxide

Ions, carbon dioxide, steroid hormones

Carbon dioxide, steroid hormones, oxygen