April 2018 MRCS A

APRIL MRCS A 2018 _ RECALLS

MRCS April 2018
Paper I

1. Tertrology of fallot is characterized by which one of the following malformations?

A. Aortic Stenosis
B. Atrial septal defects
C. Hypertrophy of left ventricle
D. Pulmonary stenosis
E. Transposition of great vessels

2. Posterolateral diaphragmatic hernia in child reason?

A. Failure of closure of right pleuroperitoneal membrane
B. Failure of closure of left pleuroperitoneal membrane
C. Pleuropericardial membbrane
D. Failure of closure of septum transversum
E. Failure of closure of contribuiton fromnthe thoracic cavity wall

3. A patient developed extradural hematoma following a road traffic accident, on examination he was found to
have inability to abduct and paralysis of downward guaze, what nerve is most likely affected?
A. Abducsence
B. Occulomotar
C. Optic
D. Facial
E. Trochlear
4. Adrenaline increases heart rate by acting on which of the following receptors
A. α 1
B. β1
C. α 2
D. β2
E. ɗ1
5. In Patients with Myasthenia Gravis, The autoantibodies are directed against which of the following?
A. Presynaptic adrenergic recerptors
B. Presynaptic Acetylcholine receptors
C. Postsynaptic Adrenergic receptors
D. Postsynaptic cholinergic receptors
E. Central cholinergic receptors
6. A patient presented with a central nervous system tumor causing paralysis of the glossopharyngeal and
vagus nerves. What is the lost likely location of the tumor?
A. Mid-brain
B. Pons
C. Medula
D. Ventricles
E. Cervical cord
7. A patient presented with involvement of the long saphenous nerve following surgery for the varicose veins.
What is the root value of the saphenous nerve
A. L2, 3
B. L 3, 4
C. L5
D. L5 S1

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E. S 1, 2
8. Hypospadias is a congenital anomaly of the penile urethra. The underlying cause is mal-development of
which of the following structures.
A. Urogenital sinus
B. Genital tubercle
C. Mesonephros
D. Genital folds
E. Mullerian duct
9. A Patient presented with fracture of the face involving maxilla and numbness over the cheek. Which of the
following nerve is most likely involved?
A. Mental
B. Infra-orbital
C. Superior alveolar
D. Auriculotemporal
E. Supratrochlear
10. P patient presented with penetrating injury in the lower part of his neck, his primary survey revealed no
major vascular injury and the patient was stable. He later was found to have hoarseness of voice. Injury to which
nerve can cause hoarseness?
A. Glasspharyngeal
B. Hypoglossal
C. Facial
D. Vagus
E. Accessory
11. Which of the following can be used as a surface landmark for external jugular vein?
A. Lobule of the ear to the Sternoclavicular joint
B. Mastoid to the Sternoclavicular joint
C. Styloid process to the Sternoclavicular joint
D. Anterior Border of sternoclidomastoid
E. The angle of mandible to the middle 3rd of clavicle
12. A patient presented with fatiguability, ptosis. Which of the following tumors can cause myasthenia like
symptoms.
A. Thymus
B. Adrenals
C. Lung
D. Liver
E. Kidney
13. A patient presented with fracture of tibia and above knee cast was applied. He later presented with pain on
plantar flexion of the great toes. Other compartments were normal. Which of the currospi=onding areas will
have paresthesia?
A. Dorsum of foot
B. Lateral border of foot
C. 1st web space
D. Medial border of foot
E. Sole of the foot.
13. A patient presented with calf pain on walking 100 mt distance. It was diagnosed as a claudication pain. Block
at Which of the following levels may responsible for the symptoms?
A. Superficial femoral
B. Popliteal
C. Deep femoral
D. External iliac
E. Profunda femoris

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14. After eating peanuts, patient developed significant wheezing and dyspnea. Which of the following cells are
responsible for these symptoms
A. Neutrophils
B. Basophils
C. Eosinophils
D. Macrophages
E. T lymphocytes
15. Sinus Tarsi is an important landmark, located between which 2 bones?
A. Talus and calcaneum
B. Talus and navicular
C. Calcaneum and navicular
D. Navicular and the metatarsals
E. Navucular and cuniforms
16. A Patient presented with crutch related Injury to axilla, he has numbness over the lateral aspect of his
forearm, which muscle will be affected as well?
A. Brachialis
B. Brachioradialis
C. Flexor carpi radialis
D. Pronator teres
E. Triceps
17. A statistician wanted to compare some parameter which was not distributed normally (the q mentioned few
patients had extremes of values) between two groups
A. Chi square
B. Mann whitney U
C. Paired T test
D. Unpaired T test
E. Kruksal wallis

18. Nerve injury following shoulder dislocation, deltoid is affected, which other muscle will be affected
A. Latissimus Dorsi
B. Teres minor
C. Teres Major
D. Subscapularis
E. Supraspinatus
19. 1. A patient was presented to emergency with palmar laceration over the radial aspect of the Left palm
at the base of the thumb. Which muscle is responsible for the movement of the thumb, when hand placed flap
on the table to bring the thumb at 900 to the plane of plam.
A. Adductor pollicis
B. Abductor pollicis
C. Opponens pollicis
D. Flexor pollicis
E. Dorsal intreossi
20. In a patient with Cleft palate, it represents defect in the embryological fusion of what structures?
A. Frontonasal
B. Maxillary
C. palatal processes
D. lateral nasal
E. medial nasal

21. Embrionic failure to develop caudal portion of Metanephros leads to what abnormality in the new born
A. Kidney
B. Uterter
C. Bladder

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D. Seminal vesicle
E. prostate

22. A patient is undergoing exploration of his brachial artery. What is the Relation of median nerve with respect
to brachial artery in proximal arm till the elbow
A. Lateral to anterior to medial
B. Anterior to lateral to posterior
C. Medial to anterior to medial
D. Lateral to anterior to lateral
E. Posterior to lateral to medial

23. A patient presented with a laceration over the volar ulnar aspect of the wrist. He is scheduled for exploration
of the wound. What is the most likely relation of ulnar nerve to ulnar artery at the wrist.
A. Anterior to the artery
B. Ulnar to the ulnar artery
C. Posterior to the artery
D. Artery if ulnar to the nerve
E. Lateral to the artery

24. Lesion in Dorsal root ganglion of a spinal nerve in the neck is most likely to lead to what time of loss?
A. Sensory
B. Motor
C. Sympathetic
D. Parasympathetic
E. All of the above

25. A patient presented with a healed laceration at the level of the elbow. Association of which nerve injury
would lead to the Atrophy of the thenar eminence muscles of the hand?
A. median nerve
B. Ulnar nerve
C. Radial nerve
D. Musculocutaneous
E. Anterior intresseous

26. A Patient presented with cervical brachial plexus injury while undergoing resection of a cervical rib. She
presented with loss of sensations over the little and ring fingers. Injury to which of the dermatomes below is
responsible for loss of sensations over the little finger?
A. C8
B. C7
C. T1
D. C6
E. C5

27. Which of the following statement is true regarding femoral canal?

A. Pectineal fascia forms the medial border
B. The inguinal ligament of posteriorly
C. The lateral border is formed by femoral vein
D. The lacunar ligament forms the lateral border
E. Fascia iliaca is posteriorly

28. Patient with known Barret’s esophagus presents with carcinoma of esophagus. what is the most likely
histological type
A. Adenocarcinoma

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B. SCC
C. Lymphoma
D. Melanoma
E. Sarcoma

29. 1. What is the most common organism causing Osteomyelitis in pediatric patients.
A. Staph aureus
B. Streptococcus pnemoniae
C. Salmonella
D. H. Influanzae
E. N. Gonorrhoae

30. Heart valve is composed of the following structure?

A. Dense fibrous tissue
B. hyaline cartilage
C. smooth muscle
D. fibrocartilage
E.

31. Lady underwent mastectomy. Split skin graft taken from thigh. What type?
A. Allograft
B. Isograft
C. Autograft
D. Meshed graft
E. Xenograft

32. Lesser sac is potential space known for intra-abdominal collections. which of the following statements
regarding lesser sac is true
A. inferior vana cave forms the lateral borber.
B. The portal vein is in the anterior free edge
C, The stomach forms the posterior wall
D. cystic duct is in the anterior free border
E. Left gastric artery is in the posterior aspect

33. A 68 years old man presented with a inguinal hernia. During repair it was found to be direct hernia. Which of
the following statemnts is correct regarding direct hernia
A. inferior epigastric artery forms the lateral border

34. which of the following statements is correct regarding the inguinal canal
Lateral 1/3rd of the posterior wall is formed by transversalis fascia

Mixed Paper I and Paper II

Q60: A caucessean girl presented with splenomegaly, jaundice and increased billurubin levels. Which of the
following is most likey disgnosis.
A. Hereditary spherocytosis

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B. Sickle cell disease

C. Acute intermittent porphyria
D. Splenosis
E. ??

1. 2 cm mass in lung in a smoker, another 1 cm mass in liver suspected to be hemangioma. No systemic signs
best investigation NEXT?
A. MRI liver
B. MRI whole body
C. CT chest
D. FDG PET CT
E. USG

2. Loss of weight, cough, tiredness, Multiple neck lymphadenopathy, Lateral aspect of tongue hair like lesions
a. Lichen planus
b. Candidiasis
c. AIDS
d. SCC
e.

3. 13 years old, overweight child, with 2 weeks history of pain in right hip, There is no history of trauma, child is not
able to bear weight. On examination: external rotation on attempting to flexion of the hip.
A. Perthes disease
B. DDH
C. Slipped upper femoral epiphyses
D. Chondromalacia
E. Fracture neck femure

4. 6 years old child presented with pain hip with all range of motions. He is systematically well, no h/ofever.
A. Perthes
B. DDH
C. Aplasia of femoral head
D. Septic arthritis
E. Juvenile Rheumatoid arthritis

5. 3 patients in surgical ward with were found to be having diarrhea. Cl. Difficile was found to be causative
organism. What is possible mode of transmission of the Clostridium difficile toxin?
A. Endogenous
B. feco-oral
C. nosocomial
D. respiratory
E. Contact

6. A 35 years old lady had collapsed suddenly and felt that something struk suddenly on the back of her lower leg,
before collapsing, while trying to cross the road. What injury must be responsible for this
a. Tendoachillis
b. Patellar tendon
c. Ankle dislocation
d. Posterior tibial nerve

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e. Tibialis posterior

7. What is the Clinical test for diagnosing a ruptured tendo-achilles?

A. Simmonds squeeze test

8. Sinus tarsi between bones?

A. Between talus and calcaneus
B. Talus and navi
C. Calc and navi

9. (retropulsion test) … EPL

10. A patient returing to UK from China after a business meeting presented with a warm swollen right thigh with
extensive mobile femoral thrombus in the femoral vein. What is the most appropriate initial management?
A. Heparin,
B. Venous exploration,
C. Aspirin,
D. Embolectomy
E. IVC filter
11. Patient Presented with tachycardia, high blood pressure and warm peripheries. Which of the following hormone
decreases with hyperthermia?
A. TSH,
B. ACTH,
C. Vasopressin
D. Cortisol
E. Catecholamine

12. A 41 years old male presented with a 2 CM Irregular swelling in his right testes. The hormonal assey was
negative for both AFP and B HCG levels. What is the most likely pathology.
A. Seminoma
B. Teratoma
C. Choriocarcinoma
D. Ledige cell tumor
E. .

13. A Patient sustained Injury to esophagus during upper GI scopy. He is being managed conservatively for a limited
perforation and mediastinitis and is Nil By Mouth. What is the Most suitable way of providing him with the
necessary nutritional support?
a. TPN
b. Fine bore Naso-gastric tube
c. PEG
d. Elemental diet
e. Naso-junal feeding

14. A patient sustained injury to his lower esophagus while undergoing upper GI endoscopy. He is being managed
conservatively with a limited air leak and is currently Nil by Mouth. For last 2 weeks.
What is the best way to confirm the healing of the perforation.
A. Water soluble contrast

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B. Barium Swallow
C. upper GI scopy
D. Endo USG
E. Chest x ray

15. A patient Operated for Crohns disease with multiple strictures for resection of distal ileum and many
stricturoplasties. He developes high output fistula with an output of 1800ml. What is the beast wasy to provide
him nutritional support?
A. Elemental diet
B. High nutrition oral or enteral diet
C. TPN
D. Feeding Jujunostomy
E.
16. What is Reciprocal of absolute risk reduction …NNT
A. Absolute Risk reduction
B. Relative risk reduction
C. Odds ratio
D. Sensitivity
E. Probability

17. A patient with Extradural Hematoma Presented to the emergency department if having hypertension and
increased intracranial pressure. What of the Following are the Components of the Cushing reflex/triad?
Heart Rate Blood Respiratory
Pressure Rate
↓ ↓
↓ ↓
↓ ↓
↓ ↓ ↓
↓

18. A 24 year old Athlete collapsed after marathon playing and could not be rescuscited. His autopsy reported
intracranial bleeding. What of the conditions below will be most likely the disgnosis?
A. Chronic SDH
B. IVH
C. EDH
D. SDH
E. SAH

19. 6 years old kid is brought by his concerned mother with a groin swelling, observed when the kid is playing
around, which spontaneously reduces on lying. What of the following may be responsible for this presentation?

A. Patent processus vaginalis

B. Direct hernia
C. Femoral hernia
D. Indirect hernia
E. Tortion testes

20. Child with pain in the right scrotum with redness and irreducible groin mass
A. direct hernia
B. femoral hernia
C. indirect hernia
D. tortion testes

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E. undescended testes

21. Lack of Which of the following factors is responsible for defect in the Intrinsic pathway of coagulation
A. Factor IXa
B. Factor VIII
C. Factor XII
D. Factor X
E. Factor VII

22. Old woman displaced # distal radius, reduced and put in slab/POP for 6 weeks. After removal of slab she is
complaining of pain and limited ROM in both supination and pronation after 3 months.
A. CRPS
B. Mal-union
C. Non-union
D. Compartment syndrome
E. .

23. A patient with Cervical lymphadenopathy was investigated and FNAC suggested squamous cell Ca. Clinical
Examination and upper tract scopy were found to be normal. What should be the next line investigation?
A. CT Neck
B. MRI neck
C. FDG PET CT
D. MRI whole body
E. Radio-istope scan

24. 35 years female presented with chronic episodic Diarrhea, pruritus ani. She was investigated for her symptoms
and the cellotape examination shows egg in stools.
A. Mebendazole
B. Metronidazole
C. Albendazole
D. Ivermectine
E. Pyrental palmoate

25. A patient presented with low blood pressure, lethargy and muscle weakness. Which of the
hypercholesterolaemia in serum analysis of this patient
A. Hyperthyroidism
B. Hypothyroidism
C. Hypertriglicridemia
D. Cortisol
E. ACTH

26. Advantage of carbohydrate rich drink in enhanced recovery program?

A. decrease post-operative insulin resistance and avoids negative nitrogen balance
B. better abdominal muscle function
C. better respiratory muscle function
D. shorter hospital stay
E. .

27. What Structure lies at the level of T5 vertebra

A. Azygos vein
B. left atrium,
C. Aortic arch OR its junction with ascending aorta

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D. Bifurcation of trachea
E. Junction of both brachiocephalic veins

28. A Man presents after overnight painting of a celing with Shoulder pain. The Pain is mainly during the movements
of shoulder between 60-120 degrees. What is the most likely disgnosis?
A. Rupture of the supraspinatus tendon
B. Subacromial bursitis
C. supraspinatus tendinitis
D. Frozen shoulder
E. Calcific tendonitis

29. A main sustains a bullet injury to his abdomen. The bullet passes directly posteriorly, enternin at a point where
the lateral border of the rectus abdominis touches the costal margin. The structure that is most likely to get
injured is
A. pylorus,
B. Gallbladder
C. Inferior vena cava
D. Posral vein
E. Cystic artery

30. What of the following lesions is most likely to cause brisk reflexes?
A. L1-2,
B. T12-L1
C. L2-L3
D. L3-L4
E. L5-S2

31. A 51 years old chinese man presents with middle ear effusion, conductive hearing loss and with LN enlargement.
What is the most likely disgnosis?
A. SCC
B. Suppurative Otritis media
C. Nasopharyngeal carcinoma
D. Adenocarcinoma
E. Infected Polyps

32. Spastic hemiplegia is caused by lesion of which artery

A. ACA
B. MCA
C. PCA
D. Ant choroidal art

33. A 38 years old male presented with compalints of severe weakeness of his lower limb and atrophy of the gluteal
muscles. On close questioning he reveals impotency. Block at what level is responsible for these symptoms
A. External Iliac
B. Common Iliac
C. Aorta
D. Bilateral femoral
E. Bilateral common Iliac

34. A 49 years old lady presented with atrial fibrillation presented with swelling, tenderness and redness over her
calf. The diagnosis of DVT can be confirmed by which of the following tests
A. color Doppler

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B. Angiography
C. Venography
D. D Diamer
E. Plathysmography

35. A 38 years Golfer with 1st Carpometacarpal joint pain. X-Ray showed narrowed joint space and subchondral
cysts. What is the most likely disgnosis?
A. Gout
B. Pseudogout
C. Osteoarthritis
D. Rheumatoid Arthritis
E. Scleroderma

36. Gangrene of the anterior abdominal wall

A. Cl. Perfringens
B. Aspergillus Fumingatus
C. Streptococcus Perfringes
D. Staphylococcus aureus
E. Pseudomonas Aurogenosa

37. A 32 years old lady collapsed and brought to emergency with shock and warm peripheries. She dies after 3 days
post operatively, what may be the causative organism for her symptoms?
A. Staphylococcus aureus
B. Pseudomonas Aerogenosa
C. Bacteriods
D. Cl. Perfringens
E. .

38. A 23 years male sustained thorasic trauma and developed hemisection of the cord. He will show the following
pattern of weakness below the level of lesion.

Motor Pain and proprioception

temprature
Ipsilateral Contralateral Ipsilateral
contralateral Ipsilateral contralateral
contralateral Ipsilateral ipsilateral
ipsilateral Contralateral Contralateral
Ipsilateral Ipsilateral Ipsilateral

39. Hypercalcemia in a metastatic scenario, Ca 3.7 mmol/L, ECG abnormalities, “Initial” treatment…
A. IV 0.9% sodium chloride
B. Steroids
C. Pamidronate
D. Cacitonin
E. .

40. A 23 years old man sustained injuries during a skeing accident, he sustained severe injuries and was recovered
and brought to the emergency department. He was found to have a temperature of 33.5 0. What is trhe possible
ECG change related to hypothermia?
A. Tall T wave
B. J wave

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C. Increased PR interval
D. Narrow QRS complex
E. .

41. A patient presented to the emergency department after collapse. Her blood investigations revealed the
following results
Values Na 119 K 2.9 Ph: 7.34 Ca 2.2
Normal Na 135- 7.35- 2.2-2.6
Range 145 7.45
She has been on Fursemide for her coingestive cardiac failure and was thought to be responsible for these
abnormalities what is the site of action of furosemide?
a. Proximal Convoluted Tubule
b. Distal Convoluted Tubule
c. Ascending limb of loop of Henle
d. Collecting duct
e. Descending limb of loop of Henle

42. A 56 years old man presented with severe electrolyte abnormalities. He has been taking Benzfluthiazide for past
many months. What is the site of action of this drug?
A. Lungs
B. Distal Convoluted tubules
C. Collecting ducts
D. .
E. .

43. A 45 years Male presented with enlarged breasts, He has been on multiple drugs. Which of the following drugs
may be responsible for producing gynaecomastia ?
A. Spironolactone
B. Amidarone

44. A 52 years old male presented with severe hematemesis. He underwent upper GI endoscopy which releaved
significant bleeding ulcer in the first part of duodenum. Which vessel may be responsible for his symptoms?
A. Left Gastric
B. Gastroepiploeic
C. Sup. Pancreaticodeodenal
D. Gastroduodenal
E. Common Hepatic Artery

45. A 30 years old man underwent successful repair of hydrocele. Where is Dartos muscle located during the
operation?
A. Between the external spermatic fascia and the cord
B. Between the internal spermatic fascia and the cord
C. Below Cremastric muscle
D. Subcutaneous
E.
46. A Man presented following his surgery with loss of hip abduction and a Waddling gait, injury to which muscle
may be responsible for this
A. Gluteus Maximus
B. Gluteus Medius
C. Pyriformis
D. Qudratus femoris
E. Obturator externus

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47. A 65 years old male with successful femoro-popliteal Bypass, presented after 3 years with pale extremity and
lack of distal pulses. He underwent a Doppler study and the graft was found to be blocked. What may be
rewsponsible for the blockade
A. Atherosclerosis
B. Neo intimal hyperplasia
C. Muscular thickening
D. Embolism
E. Thrombosis

48. COPD patient… ↑CO2 ↑HCO3

49. Anterior relation to right adrenal…IVC

50. Good prognosis for melanoma…
A. Breslow thickness of 0.6
B. Clarks level 5
C. Lymphatic invasion
D. Satellite nodules
E. Ulceration

51. 62% burn patient presents with lower leg edema after 3 days…(pain was not mentioned in the q)
A. Hypoalbuminemia
B. DVT
C.
52. A patient presented with dysphagia and history of ingestion of a fish bone. X ray of the cervical spine was
obtained and revealed the following picture. What is the structure marked with an arrow?

A. hyoid bone
B. cricoid
C. thyroid
D. epiglottis

53. Male with pain in testes and urethral discharge and fever. On closer enquiry he revealed having unprotected
sex. What is the most likely cause?
A. Gonorrhea
B. Chlamydia
C.
54. Which one of the below mentioned arteries contribute significantly to the blood supply of the transverse colon
A. Right Colic artery
B. Left Colic artery
C. Middle colic artery

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D. Iliocolic artery
E. Inferior mesenteric artery

55. A 54 years old man presented with a extradural hematoma. He had increased intracranial pressure of 20 mm hg.
His blood pressure was found to be 125/80 mm Hg. What is his cerebral perfusion pressure?
A. 90
B. 75
C. 80
D. 65.5
E. 70

56. A 38 years old man presented with recurrent swelling under his mandible for last one month. Investigations
revealed it to be calculus in the submandibular duct. He has been scheduled for removal of the calculus. Which
nerve is likey to get damaged during this surgery?
A. lingual nerve
B. Hypoglossal Nerve
C. Facial Nerve
D. Chorda tympani nerve
E. Greater auricular nerve

57. A patient underwent parotidectomy and radiation treatment for a parotid gland tumor. He subsequently
presented with symptoms of dryness of eyes, which of the following is responsible for his symptoms?
A. Pterygopalatine
B. Otic
C. Ciliary
D. Submandibular
E. Geniculate

58. A 32 years old man, cook by profession, presented with history of road traffic accident and had signs and
symptoms of increased intracranial pressure. He was found to have dilation of the ipsilateal pupil on the side of
the injury. What is the likely reason for his pupillay dilation?
A. Optic nerve injury
B. Overaction of parasympathetic stimulation
C. Facial nerve injury
D. Lack of Sympathetic innervation
E. Unopposed sympathetic stimulation

59. A lady presented with significant Osteoporotic vertebrae and has lost almost 8 cm height over the past 6 years.
She was Investigated and was found to have osteoporosis. What will her blood test reveal?
A. Hypercalcaemia
B. Hypocalcaemia
C. Normocalcemia
D. Increaed parathyroid
E. Increased phosphate

60. Some clinical scenario, hypercalcaemia, given steroids, resolved………sarcoidosis

61. HPE in rheumatoid arthritis??????
A. Necrobiotic granuloma
B. Foreign body giant cell with lymphocytes
C. Macrophages
D. Eosinophilic granuloma
62. Fall in blood BP, 1st reaction…
A. sympathetic system

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B. RAAS
C.
63. 11 year child with learning disbilities, presented with enlarged tonsils and difficulty in breathing. Laparoscopy
needs to be done urgently. Who can give concent for such procedure
A. Parental concent.
B. Patients concent
C. Ask the court
D. Can proceed without concent
E. Cannot do the procedure

64. Ligation of splenic hilum, avoid injury “during the surgery” to what…
A. tail of pancreas
B. greater curvature
C. Spenic flexure of colon
D. Disphragm
E. Ureter

65. Ureter stone radiating to groin, which nerve root… (T11-L1)

66. What structure is in front of uncinate process… SMA
67. What forms the anterior surface of the heart
A. Mostly Rt atrium and ventricle
B. Mostly left ventricle
C.
68. Pigmentation,,,, clinical picture like addisons, electrolytes Na 128, K 5.8 or 6.8, which hormone to check (ACTH)
69. Some scenario with single site metastatic bone pain treatment…
A. radiotherapy, ??
B. NSAIDs
C. PCM
D. steroid
70. Ovarian mass and inner thigh numbness, which nerve… obturator
71. Bilateral cervical lymph node spread, which type of cancer…tongue
72. Skin lesion, pearly… BCC
73. Skin lesion, central keratinous something…keratoacanthoma
74. UK NICE guidelines on people who received transfusion
A. can’t donate in future until viral markers are negative
B. Can donate within 6 weeks
C. Can donate within 12 weeks
D. 6 months
E. 12 months
75. Anterior compartment syndrome affecting… 1st dorsal web space
76. Pathology of berry aneurysm in 45yo…
A. Atherosclerosis
B. Cystic medial necrosis
77. In adults, what is a correct statement regarding lumbar puncture?
A. Preferred at the level of iliac crest as the cord ends above this level
B. at the level of transtubercular plane as the
C. Preferred at the sacral canal as the canal is widest here
D. at the level of posterior inferior iliac spine
E. At T12 level as the spinal canal is narrowest at this level

78. A 56 years patient presented with irreducible phymosis to the surgical outpatient and was found to have a
fungating mass over his glans, his superficial inguinal lymph nodes were enlarged. What is the most likely
disgnosis?

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A. Squamous cell Ca
B. Adenocarcinoma
C. Transitional cell carcinoma
D. HPV infection
E. Lichen Planus
79. A patient presented with headache, palpitation, and refractory hypertension. Which of the following
investigation would help to support the disgnosis of pheochromocytoma?
A. Urinary VMA
B. Urinary cortisol
C. 1-25 hydroxycholecalciferol
D.
80. post-op day 6 , operated after trauma, with continued bleeding PT 18 secs, APTT 60 secs, Fibrinogen 0.1 … (DIC)
81. A hypertensive taking Ramipril for controlling his blood pressure. Which of the following causes constriction of
efferent arteriole?
A. Angiotensin I
B. renin
C. Angiotensin II
D. aldosterone
E. Angiotensinogen

82. A 45 years old male presented with a swelling over the posterior aspect of the knee and pain. He was on
conservative management and presented 7 days later with swelling over his calf and induration, the swelling in
the posterior aspect of the knee had disappeared. What is the most likely diagnosis during this presentation.
A. Ruptured backers cyst
B. Deep venous thrombosis
C. Varicose veins
D. Aneurysm of popliteal artery
E. Pseudoaneurysm

83. A patient presented with a right iliac fossa mass and investigations confirmed a caecal cancer. He underwent
resection. The resected specimen was reported as T4, what do u mean by this stage?
A. Involving surrounding abdominal musculature
B. Multiple lesions in the resected specimen
C. Muscle invasion
D. Lymphatic or vascular invasion
E. Involvement of liver or lung

84. A patient presented after thyroidectomy for graves disease with sweating, diarrhea, a pulse rate of 120, BP
160/110 mm hg, what is the treatment of choice in this case?
A. betablocker + iodide
B. betablocker + thioamides
C. Iodides and thioamides
D.
85. A patient presented with renal stones and sr. Ca 2.94 mmoles/L, what is the best investigation of choice for
solitary parathyroid adenoma
A. Sestamibi scan
B. USG
C. CT
D. MRI
E. I131 uptake scan

86. Can’t remember, most likely risk factor for HCC… (alcohol)

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 April 2018 MRCS A

87. A 40 years male presented with nausea, and headache, the symptoms were severe particularly in the morning.
On examination there were no focal neuro signs, but fundoscopic examination revealed papilloedema. What
may be the most likely underlying cause?
A. Raised ICT
B. Frontal glioma
C. EDH
D. SDH
E. SAH

88. A Patient presented with back pain. X ray revealed multiple osteolytic lesions in the vertebrae. A disgnosis of
multiple myeloma was made based on the presentation. Bone marrow aspitrations is most likely to reveal which
of the following?
A. Plasma cells
B. Macrophages
C. Lymphocytes
D. Eosinophils
E. Negative bifringent crystals

89. Asian middle aged man, presented with cough and weight loss, x ray revealed mass in the upper lobe of the lung,
he also had mediastinal lymphadenopathy. HPE of the mass would most likely reveal
A. Squamous cell Carcinoma
B. Small cell carcinoma
C. Tuberculosis
D. Adenocarcinoma
E. Sarcoidosis

90. A patient presented with urethral meatus opening over the dorsal surface of the penis. This anmoly is commonly
associated with which of the following.
A. Extrophy of bladder
B. Exomphalos
C. Spina Bifida
D.

91. Can’t remember, some question about diffuse lung infiltrates or ARDS, cause of clinical picture?
92. At a pre-anesthesia clinic, spirometry was advised for a patient. Which of the following statements is correct
regarding the lung volumes or capacities?
A. Vital Capacity is sum of inspiratory reserve volume, tidal volume and expiratory
reserve volume
B. Total Lung capacity is a sum of inspiratory reserve volume and vital capacity
C. Functional reserve capacity is a sum of inspiratory reserve volume and residual
volume?
D. Expiratory reserve volume is ?

93. 30 years old man, presented with Mediastinal mass. FNAC shows glandular pattern, absence of neuroendocrine
markers, ill-defined clumps of cells.
A. Adenocarcinoma ??
B. Thymoma ??
94. Some trauma or surgery on condyles of femur or tibia. Followed by loss of pulsations. Injury? .... (popliteal)
95. Patient with liver laceration, during ot clamp free margin of lesser omentum. Possible damage to?
A. CBD
B. Hepatic vein
C. IVC
D. Cystic duct

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 April 2018 MRCS A

E. Common hepatic artery

96. Post cardiac transplant patient wants to join fitness club as he read somewhere that his low heart rate can be
compensated by exercises. Which of the following increases Cardiac output in a cardiac patient, during
controlled exercises?
A. Increased atrial filling
B. Increased intrathoracic pressure
C. Increased intrapericardial pressure
D. Some option acting via autonomic nervous system
E. Peripheral vasoconstriction

97. Ureter relations,

A. Gonadal veins Cross anteriorly
B. Common iliac divide anteriorly
C.
98. pain on walking down hill but not uphill… (spinal stenosis)
99. patient post burn, with hematemeses… (acute gastric dilatation)
100. multiple bone pains, on exam, illdefined hard prostrate , PSA 300. Management?
A. TURP,
B. radical prostatectomy,
C. incision of prostrate
D. hormonal therapy
E. active surveillance
101. long standing venous ulcer, swabbed , found to have MRSA, no signs of infection given in the q
A. oral lincopeptides( Vanco or Teico)
B. other beta lactams
C. beta lactams
D. beta lactams
E. no antibiotics

102. effect of smokig on body

103. trauma patient, “properly resuscitated”, when log rolling , suddenly became hypoxic or decompensated
A. displacement of tracheal tube
B. spinal injury

104. history of carrying heavy weight with back pain….facet arthropathy

105. tooth extraction, bleeding stopped then, started after some time….Factor VIII
106. mass in breast of 25 yr lady, mobile, non tender, what inv ?
A. USG
B. Mammo

107. Post op patient of zygomatic repositioning, ear discharge, deafness …#petrous part
108. Pharyngeal pouch, between which muscles?... Thyropharyngeus and cricopharyngeus
109. 16 years old boy with gynaecomastia …..physiological)
110. Renal mass noted in USG. Next investigation?
A. CT
B. MRI
C. FNAC
D. PET?
111. Vessel originating above piriformis….sup gluteal
112. Trendelenberg test +ve……. gluteus medius

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 April 2018 MRCS A

113. Post op patient deteriorating picture, P 60-70, BP 80/50, CVP 20

A. Heart block
B. Sepsis
C. Cardiac failure
114. Acute abdomen, amylase 110 [normal below 100], Ca 2.4 [2.1 – 2.8], LFT normal picture,
A. Acute intermittent porphyria
B. Perforation
C. Pancreatitis
D. Rest of the options I don’t remember , but nothing matching the q
E.
115. Type 1 Diabetic patient on long term NSAID for osteoarthritis or some painful condition, post op creat high,
urea high
A. Reduced renal perfusion
B. Diabetic nephropathy
C. NSAID induced renal injury
D.
116. Etiopathogenesis of AAA……..atherosclerosis
117. Patient known case of iliac or femoral atherosclerosis or aneurysm. Came with sudden onset pale pulseless
limb….embolism
118. Patient with known periph vasc ds, underwent fem-distal bypass 1 yr back, now came with painful limb, DPA
not palpable, but doppler showing monophasic flow until ends…. DVT
119. Mass in breast, with eczema of nipple areola. Q was , apart from mammo what else will u do?
A. Exfoliative cytology
B. FNAC
C. Biopsy
D. MRI
120. Which of the following is true about Rt coronary artery?
A. Originates posteriorly from aorta
B. ………………anteriorly…………………
C. Originates from aortic sinus below the aortic valves
D. Present in posterior IV groove
121. Angle of loiu…junction of arch and descending
122. Another q Structure at/attached to T5..
A. Left atrium
B. Tracheal bifurcation
C. Bifurcation of pulmonary trunk
D. Bifurcation of right bronchus
E.

123. Some surgery led to injury to thoracic duct, surgeon wants to ligate it from thoracic approach. Where to find
A. Behind ascending aorta
B. Venecaval opening
C. Esophageal opening
D. Aortic hiatus
E. At junction with the subclavian vein

124. Post appendectomy, most likely site of pus collection in…..

A. rectouterine pouch
B. vesicouterine ”
C. behind the rectum
D. in front of bladder
125. Lymph Nodes involved in Scrotal infection… (superficial inguinal)
126. Ovary… (para aortic)

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 April 2018 MRCS A

127. At anal verge (superficial inguinal)

128. Middle aged man, testicular mass, HPE shows cells separated by fibrous septa containing lymphocytes…
A. Classical seminoma
B. Spermatocytic seminoma
129. Surface marking of IJV
A. styloid process to medial end of clavicle
B. ear lobule to medial end of clavicle
C. mastoid process to medial end of clavicle
D. lesser cornu of hyoid to medial end of clavicle
130. myasthenia……antibodies to acetylcholine
131. NSAIDS causing ulcer…by what mechanism … Cyclooxygenase
132. Mechanism of peptic ulcer
A. Mucous cells
B. Chief cells
C. Oxyntic cells
133. Gunshot which entered at the junction of right rectus and right costal cartilage and exits exactly from the
opposite. Structure most likely injured ?
A. GB
B. Renal hilum
C. Pylorus
134. Some surgery on leg done under spinal with anaesthesia upto umbilicus…..T10
135. Patient with 9th 10th 11th and 12th cranial nerve lesion… medulla
136. Cause of metabolic alkalosis?
A. Nasogastric aspiration
B. Alcohol
137. Post op gustatory sweating….. parasym fibres developing into sweat glands
138. Some scenario and inj ampicillin or amoxicillin given; soon presented with scenario of anaphy rxn. Mediator?
A. Mast cells
B. Eosinophils
C. Lymphocytes
D. Macrophages

EMQs: Bladder Cancer

B. Adenocarcinoma
C. Squamous cell Carcoinoma
D. Transitional cell Ca localized to mucosa
E. Infiltrative Transitional cell Ca
71. A Female with meningomyelocoele and bladder neck obstruction is on self catheterization program and has
history of multiple recurrent infections, presents significant hemturia hematuria ??SCC
72. 56 years Male with long history of smoking presented with hematuria, during investigations he was found to
have filling defect in his bladder in his IVU… TCC
73. A 56 years old Egyptian, working in UK presented with painless hematuria ??SCC

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 April 2018 MRCS A

EMQ on Ear
74. Discharge from ear for a 10 years, with middle ear perf and facial nerve palsy…cholesteatoma
75. … ()
76. … ()
77. Some kind of mass in neck? Don’t rememebr ……….Otitis media with effusion

Stupid EMQ on Jaundice

78. Man with pain, jaundice, fever….had similar episodes of pain abdo previously….choledocholithiasis
(cholangitis was not in options)
79. 30 yrs follow up patient of FAP operated for pancolectomy, now presented with Jaundice and bilious
vomitting… Carcinoma of duodenum
80. … ()
81. … ()

EMQ Fluid burn calculation in 24h

82. 36% burn in some 60 or 70 kg
83. 19 yr old with 90 kg weight with burn of a lower limbs and perineum

EMQ chest trauma

i. Chest drain
ii. Chest drain with suction
iii. CT
iv. Echo
v. Thoracotomy
84. Stab to right 4th ICS, normal CXR, tachy, rest normal
85. Stab to the left 5th ICS, tachy, rest normal
86. Stab to 5th ICS post axillary line, CXR showing pneumothorax with fluid level

EMQ Chest pain in pregnancy

87. 36 weeks, 28 yr, c/o Chest tightness and dyspnea. On exam, cyanosis and one more alarming feature. Dad
died of AMI at 62 yrs…..AMI
88. 36 weeks, 28 yrs, father died of AMI at 42 yrs, chest pain, no other info. Exceptionally(word used was some
different) tall….. Aortic Dissection
89. 36 weeks, 28 yrs, Preg lady with pleuritic chest pain followed by dyspnoea, father died at 60…. PE

EMQ Child gastrointestinal disorders

90. 6 months, sausage shaped mass…intussusception
91. 6 weeks non bile stained vomit after feeds…pyloric stenosis
92. Tender distended abdomen, per rectal bleed in 6 weeks baby……midgut volvulus
93. …

EMQ GCS
94. E2V2M2
95. E1V1M1

EMQ Ortho patterns of fracture

96. Twisting force… spiral

97. Child fracture with bowing happening after injury greenstick
98. Direct blow to femur… transverse
99. Fracture humerus with metastatic lesion, mechanism was fracture happened while she was trying to aboard
a bus and got pulled by the running bus oblique

EMQ Ortho nerve injury

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 April 2018 MRCS A

100. Posterior approach to femur… (tibial? common peroneal? posterior cutaneous nv of thigh?) (sciatic
was not in option)
101. Humerus posterior approach… radial
102. Medial approach to ankle… saphenous nerve

EMQ urethral injury

103. Pelvic fracture, unstable patient, DRE prostate unusual location… rupture membranous urethra
104. Fall with legs wide open on handle bar bulbar urethra injury

EMQ plastic
EMQ Thyroid
105. 1 cm MCT … total thyroidectomy
106. 0.5 cm nodule found in one lobe of thyroid while operating for another surgery probably
parathyroid… hemithyroidectomy

EMQ Types of biopsy

107. Medial malleolus Venous ulcer…incision biopsy
108. Solitary lesion in thyroid
109. 1 cm lesion over back, suspected melanoma
110. Weeping lesion over the nipple areolar complex, no palpable mass.

EMQ on Splenomegaly
111. Caucasian man, antibodies to EBV +... (Infectious Mononucleosis)
112. Jaundice, splenomegaly and multiple gall stomes: pigment stones

EMQs:
A. Full thickness graft
B. Partial thickness graft
C. Pedicled flap
D. Microvascular free flap
E. Advancement flap
F. Wound excision and primary closure
G. Wound excision and 2nd ry closure
H. Healing by secondary intension

61. Patient presented with h/o Dog-bite, part of the nose is lost
62. Cut wound scalp with dirty wound edges
63. Garden fork in injury to the dorsum of foot with around 1cm area around that is dusky indurated.
64. Patient Presented with burns over around 20% body surface area of which 5% area is deep

-Knee Injury
A. Medial Collateral Ligament injury
B. Lateral Collateral injury
C. Medial meniscus tear
D. Lateral meniscus tear
E. Anterior cruciate Ligament
F. Posterior Cruciate Ligament
G. Fracture tibial Platue
H. Tibiofibular Dissociation

68. Twisted his Rt knee, as it got stuck in mud while playing football. He continued to play, but developed swelling in
the evening, Presented 2 weeks later with pain around 2 cm above joint line and excess opening on varus stress
testing.

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 April 2018 MRCS A

69. 35 yr. male with Injury to left knee sustained during a Road traffic accident. There is no apparent deformity and
no fractures, During examination, the flexed position of the knee at 90 degrees tibia is more posterior on left side
than right.

1. 1cm melanoma over the back, best management…

A. excision biopsy with 2mm margin,
B. excision biopsy with 2cm margin
C. core biopsy
D.
2. 23-25 yr old female, single mobile breast mass, most appropriate investigation
A. USG
B. Mammo
C.

RK