2019

Recalls

April 2019 MRCS I.V.

 MRCS I.V. Course

April 2019 recalls

1. A 26-year-old man presents to the Emergency Department with extensive bleeding from his arm
after sustaining a glass injury. On examination there is a 7 cm transverse laceration across the
anterior aspect of his elbow. On exploring the cubital fossa, you would expect the brachial artery
to be:
A. anterior to the median nerve
B. lateral to the biceps tendon
C. lateral to the median nerve
D. medial to the median nerve
E. superficial to the bicipital aponeurosis

2. A 19-year-old woman presents to the Emergency Department profoundly hypovolemic having

fallen from a horse. A postero-anterior (PA) chest radiograph shows a fracture to the medial third
of the left clavicle. Which of the following vessels is most likely to be damaged?
A. Brachiocephalic trunk
B. Left axillary artery
C. Left common carotid artery
D. Left subclavian artery
E. Left vertebral artery

3. A patient can't dorsiflex his big toe, which nerve root is most likely to be involved?
A. T12
B. L3
C. L5
D. S1
E. S2

4. A Patient fell at his wrist resulting in loss of sensation over the palmar aspect of the lateral 3 and
half fingers. What is the expected injury causing this?
A. Scaphoid fracture
B. Lunate dislocation
C. Distal radial fracture
D. Distal ulnar fracture
E. Hamate fracture
5. A 28-year-old man presents with pain in his left scrotum. A diagnosis of varicocele is made.
Which vessel is involved?
A. Gonadal vein
B. Inferior epigastric vein
C. Pudendal artery
D. Artery of the vas
E. None of the above

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6. During recovery from varicose veins surgery, a 35 years old woman complains of weakness of
dorsiflexion of the ankle. Physical examination reveals absent sensation over the dorsum of the
foot. Which of the following nerves is most likely injured?
A. Common peroneal nerve
B. Deep peroneal nerve
C. Saphenous nerve
D. Superficial peroneal nerve
E. Sural nerve

7. A 70-year-old man undergoes transurethral resection of bladder tumour (TURBT). The tumour
lies over the lateral side wall of the bladder just above the opening of the right ureteric orifice.
Use of the diathermy suddenly causes the patient to 'kick' because of contraction of the hip
adductor's muscles. Which nerve has been stimulated?
A. Femoral nerve
B. Genitofemoral nerve
C. Lateral femoral cutaneous nerve
D. Obturator nerve
E. Sciatic nerve

8. A patient sustained a fracture tibia for which he was put in a cast for 5 weeks. He then developed
severe pain in his leg with pain on plantar flexion. Where would you expect sensory loss?
A. Lateral aspect of the foot
B. Medial aspect of the leg
C. Dorsum of the foot except 1st web space
D. First web space
E. None of the above

9. What is the corresponding dermatome of the little finger?

A. C8
B. C7
C. C6
D. T1
E. C5

10. A patient became unable to dorsiflex his big toe. What is the corresponding spinal root?
A. S1
B. L4
C. L5
D. L3
E. S2

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11. What is the relation of ulnar nerve to the ulnar artery at wrist?
A. Ulnar nerve is ulnar to ulnar artery
B. Ulnar nerve is radial to the ulnar artery
C. Ulnar artery is ulnar to the ulnar nerve
D. Ulnar nerve is lateral to the ulnar artery
E. None of the above

12. A 70-year-old woman from a nursing home is brought to the Emergency Department with
abdominal pain and vomiting. On examination, she is dehydrated, and her abdomen is distended.
There is a 3 cm x 4 cm swelling in the right groin, which is nontender, and there is no cough
impulse. At operation, a femoral hernia is found. Which one of the following lies immediately
lateral to the hernial neck?
A. Femoral artery
B. Lacunar ligament
C. Pectineal ligament
D. Inguinal ligament
E. Femoral vein

13. A 1-year-old girl with a minimally displaced spiral fracture to her tibia, what is the best
management to be done?
A. External fixation
B. Cast from groin to foot
C. Intramedullary nailing
D. Internal fixation with plates
E. None of the above

14. A 30-year-old patient came with sub capital fracture managed by closed reduction, with
excellent prognosis and follow-up, came after 1 year with pain and hip stiffness. What is the
diagnosis?
A. Avascular necrosis
B. malunion
C. Nonunion
D. Osteoarthritis
E. None of the above

15. A 10-year-old boy fall while playing on his outstretched hand, on examination he minimal pain
and swelling at site of injury, what is the type of fracture to be found in x-ray?
A. Transverse
B. Comminuted
C. Oblique
D. Spiral
E. Greenstick

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16. A young male presented with first metatarsal pain, X-ray showed reduced joint space and
subchondral cysts, what's the diagnosis?
A. Pseudo gout
B. Rheumatoid arthritis
C. Gout
D. Osteoarthritis
E. Avascular necrosis

17. A diabetic patient underwent a below knee amputation, then developed a swollen stump,
shortness of breath and chest pain, what is the most likely diagnosis?
A. Pulmonary embolism
B. Gas gangrene
C. Myocardial infarction
D. Pneumonia
E. Cardiac tamponade

18. A diabetic patient underwent a below knee amputation, but the patient developed fever,
swollen red stump and crepitus. What is your provisional diagnosis?
A. Anthrax
B. DVT
C. Gas gangrene
D. Cellulitis
E. None of the above

19. A 50-year-old lady with a long bone fracture, has low Ca level and high ALP. what is the
diagnosis?
A. Paget’s disease
B. Osteoporosis
C. Osteomalacia
D. Metastatic bone tumor
E. Rickets

20. A 75-year-old man presented with backpain for 1 month and irregular urine stream. On PR
examination he has hard prostate mass, his PSA is more than 300. What is the first line of
treatment regarding his state?
A. Hormonal therapy
B. Radiotherapy
C. Watchful waiting
D. Radical prostatectomy
E. Orchiectomy

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21. A patient with absent dorsalis pedis and posterior tibial artery pulses after RTA. He has no
sensation below knee, and his leg was internally rotated. What is the likely cause?
A. Neck of femur fracture
B. Posterior hip dislocation with sciatic nerve injury
C. Anterior hip dislocation
D. Fracture distal femur
E. None of the above

22. A 25 years old athlete came with a single rib fracture. He is in pain, but he is vitally stable. What
is the most appropriate management?
A. Chest drain
B. Admission, observation and analgesia
C. Analgesia and discharge
D. Infiltration of wound with 5% bupivacaine
E. None of the above

23. A 59 years old COPD patient came with a rib fracture. X-ray was done with no hemo or
pneumothorax detected, but the patient is in pain. What is the most appropriate management?
A. Chest drain
B. Admission, observation and analgesia
C. Analgesia and discharge
D. Infiltration of wound with 5% bupivacaine
E. None of the above

24. A 34 years old patient presented after chest trauma. The trauma affected the ribs from 5th to
10th which were fractured. The patient is cyanosed and tachycardic. What is the most
appropriate management?
A. Chest drain
B. Admission, observation and analgesia
C. Analgesia and discharge
D. Infiltration of wound with 5% bupivacaine
E. None of the above

25. A 32 years old athlete patient presented with restrictive movement of whole spine at all
regions. He denies any history of trauma. What is the most likely cause?
A. Ankylosing spondylitis
B. Spondylolisthesis
C. Spondylolysis
D. Spinal canal stenosis
E. Spina bifida

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26. A 45 years old male presented with frequency and urgency. On cystogram and after voiding, he
feels incomplete emptying. He was found to have increased intravesical pressure with residual
volume of 200ml. What is the most likely cause?
A. BPH
B. Bladder outlet obstruction
C. Bladder diverticulum
D. Urethral stenosis
E. Underactive bladder

27. A 49 years old female has nephrostomy for infected hydronephrosis 3 months ago. She is now
undergoing hysterectomy for a fibroid. What is the best investigation for follow up of
hydronephrosis?
A. Antegrade urethrogram
B. Retrograde urethrogram
C. CT abdomen
D. MRI
E. USS

28. The most common reported infection transmitted by needle prick is:
A. Hepatitis C
B. Hepatitis B
C. HIV
D. Herpes simplex virus
E. CMV

29. A 6-year-old boy brought by his mother with a scrotal swelling which disappears on lying down.
What is the most likely cause?
A. Patent processus vaginalis
B. Undescended testis
C. Direct inguinal hernia
D. Epidydimal cyst
E. None of the above

30. An 8 years old child presented with right leg fracture. Onion peal appearance was detected in x-
ray. What is the most likely diagnosis?
A. Stress fracture
B. Osteosarcoma
C. Multiple myeloma
D. Ewing sarcoma
E. Paget’s disease of bone

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31. A young lady suddenly fell after feeling a sudden pain in the back of her ankle while walking.
What is the test to be positive?
A. Thomas test
B. Phalen test
C. Simmonds Thompson test
D. Froment test
E. Retropulsion test

32. A 35 years old female sustained urinary incontinence obstructed labor. Which nerve root is
responsible?
A. S1, S2, S3
B. S2, S3, S4
C. S3, S4, S5
D. L5,S1,S2
E. L4,L5,S1

33. A 53 years old man presented with painless hematuria and weight loss. Investigations revealed
a urinary bladder mass. What is the most probable histological finding you would expect?
A. Urothelial cell carcinoma
B. Squamous cell carcinoma
C. Adenocarcinoma
D. Signet ring carcinoma
E. None of the above

34. What is the motor nerve supply of dorsal interosseous muscle of the ring finger?
A. Recurrent median nerve
B. Anterior interosseus nerve
C. Deep branch of radial nerve
D. Posterior interosseus nerve
E. Deep ulnar nerve

35. An athlete suffered RTA resulting in a medially rotated thigh with a large swelling at the
midthigh. What is the most likely underlying diagnosis?
A. Neck of femur fracture
B. Posterior hip dislocation with sciatic nerve injury
C. Anterior hip dislocation
D. Fracture shaft femur
E. None of the above

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36. A patient is unable to medially rotate the thigh. What is the affected nerve?
A. Superior gluteal nerve
B. Inferior gluteal nerve
C. Femoral nerve
D. Sciatic nerve
E. Pudendal nerve

37. A 53 years old man fell on his left forearm. On examination, there’s numbness over the first
dorsal web space of hand. Which nerve is involved?
A. Posterior interosseus nerve
B. Superficial ulnar nerve
C. Radial nerve
D. Palmar branch of median nerve
E. Anterior interosseus nerve

38. A 53 years old diabetic hand worker presented with a fixed bent left ring finger. Extending the
finger produces a popping sound. What is the most likely diagnosis?
A. Rheumatoid arthritis
B. Carpal tunnel syndrome
C. Trigger finger
D. Heberden disease
E. None of the above

39. What is the spinal route value of tibial nerve?

A. L4-S3
B. L2-4
C. S2,3,4
D. L3,4
E. L2,3

40. In popliteal fossa, what is accurate relation of popliteal artery?

A. Most lateral, most deep
B. Most medial, most superficial
C. Most medially, most deep
D. Most lateral, most superficial
E. None of the above

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41. A 45-year-old man presents with backache and leg pain due to a prolapsed lumbar
intervertebral disc. The pain, which is aggravated by coughing and sneezing, radiates to the
lateral aspect of the foot. On examination, there is weakness of the plantar flexors of the foot,
which nerve root is most likely to be involved?
A. L5
B. L4
C. S1
D. L3
E. None of the above

42. A 42 years old woman has a cholecystectomy and develops a self-limiting postoperative wound
infection. By what process would bacterial ingestion have been enhanced?
A. Apoptosis
B. Autophagy
C. Metaplasia
D. Opsonization
E. Phagocytosis

43. A 58-year-old woman presented to the Emergency Department with a large fluctuant swelling
at the site of a recent insect bite. She is anxious, tachycardic, and pyrexia. ECG shows critical
fibrillation. She is noted to have a goiter. The swelling at the site of the bite requires surgical
drainage. Which of the following classes of drug would be most appropriate as part of her
preoperative preparation for surgery?
A. Alpha-1 adrenoceptor agonist
B. Alpha-2 adrenoceptor agonist
C. Alpha adrenoceptor blocker
D. Beta adrenoceptor agonist
E. Beta adrenoceptor blocker

44. A 45-year-old man has established cirrhosis. At a follow-up appointment a palpable spleen four
fingers breadths below the costal margin is noticed. Full blood counts have shown a persistent
thrombocytopenia. Bone marrow examination shows megakaryocyte hyperplasia. What is the
most likely cause of the thrombocytopenia?
A. Ineffective production in the bone marrow
B. Platelet destruction in the bone marrow
C. Platelet destruction in the liver
D. Platelet destruction in the spleen
E. Platelet storage in the spleen

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45. Patient with graves' disease came after 12 months with relapse. what to give her now?
A. Propylthiouracil
B. Propranolol
C. Steroids
D. Carbimazole
E. None of the above

46. A young man stabbed in the Left 5th ICS, he is vitally stable apart of tachycardia, normal chest
x-ray, what is the next step to do?
A. Echocardiogram
B. Ct scan
C. thoracotomy
D. insert chest drain
E. MRA

47. An 18-year old woman recently started the combined oral contraceptive pill and present with
acute abdominal pain, vomiting and muscle weakness on examination she has a pulse rate of
86beat/minute and her blood pressure is 160/85 mmHg other findings are:
Result Normal
Serum amylase 110 IU/L <100
Serum ALT (alanine transferase) 22 IU/L <50
Alkaline phosphatase 102 IU/L 50-120

Albumin 41 g/L 35-50

Gamma GT 37 IU/L <60
Bilirubin 10 mol/L 0-20
calcium 2.41 mmol/L 2.20-2.70
Plasma glucose 5.0 mmol/L
Triglycerides 1.5 mmol/L <1.7

What is the most likely diagnosis?

A. Acute intermittent porphyria
B. Diabetic ketoacidosis
C. Hypoparathyroidism
D. Mumps
E. Pancreatitis

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48. A 20-year-old woman presents acutely with abdominal pain. Imaging reveals a right ovarian
cystic lesion which is excised. Histological examination shows a cyst lined by keratinizing
stratified squamous epithelium. Areas of fat, muscle, thyroid and neural tissue are seen in the
wall. What is the appropriate pathological designation for this lesion?
A. Cystadenoma
B. Dysgerminoma.
C. Mesenchymoma
D. Squamous cell carcinoma
E. Teratoma

49. A 33-year-old lady with breast implant and she was worried as she has a strong family history of
breast carcinoma, how to screen for breast cancer?
A. MRI
B. US
C. Mammography
D. FNAC
E. None of the above

50. A 23-year-old girl presented with lump in her right breast. How to investigate for this lump?
A. Mammography
B. U/S
C. MRI
D. X-RAY
E. FNAC

51. A 33 years old lactating female presented with breast swelling and redness not responding to
antibiotics. what is your provisional diagnosis?
A. Inflammatory breast malignancy
B. Cellulitis
C. Lactational mastitis
D. Duct ectasia
E. Breast T.B

52. Which of the following is a breast cancer marker?

A. CEA
B. CA 72-9
C. HIAA
D. Chromogranin A
E. None of the above

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53. A 33 years old patient had splenectomy. What to give her as post splenectomy vaccines?
A. Streptococcus pneumonia vaccine.
B. Streptococcus pneumoniae, Hemophilus influenzae type B vaccines.
C. Streptococcus pneumoniae, Hemophilus influenzae type B, and Neisseria meningitides
vaccines
D. Streptococcus pneumoniae, Hemophilus influenzae type B, and Neisseria meningitides
Vaccines and penicillin
E. None of the above

54. A Chinese lady has conductive hearing loss, palatine ulcer and cervical lymphadenopathy, most
likely diagnosis could be?
A. Nasopharyngeal carcinoma
B. Oropharyngeal carcinoma
C. TB
D. Infectious mononucleosis
E. Maxillary sinusitis

55. A 9-year-old infant presented with fever and tender red mass below angle of mandible what is
your diagnosis?
A. Submandibular abscess
B. Branchial cyst
C. Sebaceous cyst
D. Submandibular gland tumor
E. None of the above

56. A 66 years old patient has lung cancer, during his metastasis work up, their were brain
Metastatic lesions What is the best drug to give for him?
A. Dexamethasone
B. Radiotherapy
C. NSAID
D. Morphine
E. Mannitol

57. A previously fit 21-year-old man collapses while running a Marathon. Resuscitations
unsuccessful a pos-mortem examination shows an intracranial hemorrhage. what is the most
likely site of the hemorrhage?
A. Intraventricular hemorrhage
B. Chronic sub Dural bleed
C. Acute sub Dural bleed
D. Extra Dural hemorrhage
E. Subarachnoid hemorrhage

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58. A patient hit by stick, has depressed skull fracture, with no vomiting or loss of
consciousness. What is the next step?
A. CT within 2 hours
B. CT within 8 hours
C. call neurosurgeon
D. admission under observation
E. craniotomy

59. A patient came after RTA, his GCS was less than 10, after log rolling, he suddenly became
hypoxic with rapid decrease in po2 what is your explanation?
A. Respiratory center depression
B. Spinal cord injury
C. Tracheal tube displacement
D. Pneumothorax
E. Large amount of hemorrhage

60. Post splenectomy, what is the blood component affected firstly in CBC?
A. Platelets causing thrombocytosis
B. Platelets causing thrombocytopenia
C. Reticulocytes
D. Eosinophils
E. Granulocytes

61. A 45-year-old homeless man presents with a cough and weight loss over three months. On
examination his BMI (Body Mass Index) is 19 and he has reduced breath sounds in the right
upper zone. His chest X-ray shows a caveating lesion in the right upper lobe. He undergoes a
bronchoscopy and a bronchial biopsy. The biopsy shows featureless necrosis surrounded by
epithelioid macrophages and giant cells. Which of the following is the most likely diagnosis?
A. Actinomycosis
B. Bronchiectasis
C. Sarcoidosis
D. Squamous cell carcinoma
E. Tuberculosis

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62. A 30-year-old woman presents to the general surgical clinic with a 1.5 cm cervical lymph node
along the anterior border of sternocleidomastoid muscle. Clinical examination and routine blood
tests are unremarkable. She undergoes an excisional biopsy of the lump as a day case. The
histology report reveals encapsulated infiltrative carcinoma with marked fibrosis and cystic
changes within the lymph node. What is the most likely primary pathology?
A. Papillary thyroid carcinoma
B. Follicular thyroid carcinoma
C. Anaplastic thyroid cancer
D. Lymphoma
E. Medullary thyroid cancer

63. A 22-year-old man has been stabbed in the left fifth intercostal space at the edge of the
sternum. Which structure is most likely to have been penetrated?
A. Left atrium
B. Left lobe of the liver
C. Left ventricle
D. Right atrium
E. Right ventricle
64. A 30-year-old man is admitted to the intensive care unit with an isolated severe head injury. A
CT scan shows multiple intracerebral bleeds but no midline shift. He is intubated and ventilated.
His pupils are dilated and react sluggishly to light. His heart rate is 50 beats/minute blood
pressure 170/110 mmHg and his respiratory rate is set at 10 breaths/minute. The rising blood
pressure is likely to be caused by:
A. aortic and carotid baroreceptor stimulation
B. Cortisol stimulation
C. renin-angiotensin stimulation
D. sympathetic stimulation related to blood loss
E. sympathetic stimulation related to intracranial pressure

65. A 62-year-old woman presents to her General Practitioner with a two-week history of back
pain. She has lost 8 cm in height over the last five years Investigations revealed Findings:
Results Normal
Corrected calcium 2.78 mmol/L 2.15- 2.55 mmol/L
Phosphate .84 mmol/L .8 -1.4 mmol/L
GFR .96 ml/min More than 90
PTH 8.9 pmol/L .95 -5.7

A. Secondary hyperparathyroidism
B. Tertiary hyperparathyroidism
C. Hypoparathyroidism
D. Osteoporosis
E. Primary hyperparathyroidism

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66. The right and left pulmonary arteries are derived from which of the following embryological
aortic arches? (ductus arteriosus as well-new)
A. Second aortic arch
B. Third aortic arch
C. Fourth aortic arch
D. Fifth aortic arch
E. Sixth aortic arch

67. Activation of which of the following transport systems best describes how aldosterone leads to
maintenance of the intravascular volume and oliguria?
A. Na+/glucose in the proximal tubule
B. Na/H+ in the descending loop of Henle
C. Na+/K in the ascending loop of Henle
D. Na+/Cl in the distal tubule
E. Na/K in the collecting ducts

68. A 69-year-old man has been admitted to the high dependency unit following an anterior
resection under general anesthesia. He was given 2 mg of intrathecal morphine. On examination,
he looks pale and drowsy. Arterial blood gasses results are:

Which of the following is the most likely diagnosis?

A. Diabetic ketoacidosis
B. Metabolic acidosis
C. Metabolic alkalosis
D. Respiratory acidosis
E. Respiratory Alkalosis

69. Pericardio-peritoneal membrane defect will lead to:

A. Congenital Diaphragmatic hernia
B. Ectopia cordis
C. Hiatus hernia
D. Eventration of diaphragm
E. Dextrocardia
70. Facial nerve transection during parotidectomy will lead to all of the following except:
A. numbness over the cheek
B. loss of corneal reflex
C. lower lip dropping
D. drop angle of the mouth
E. none of the above

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71. Post parotidectomy, a patient developed gustatory sweating during meals. What is the
mechanism?
A. Regeneration of the parasympathetic fibers of auriculotemporal nerve into sympathetic
fibers innervating the sweat gland
B. Regeneration of sympathetic fibers on the parasympathetic of auriculotemporal nerve
C. Regeneration of facial nerve after its injury
D. Regeneration of great auricular nerve on sympathetic fibers innervating the sweat gland
E. None of the above

72. A 32 years old patient with pancreatitis. What is the enzyme responsible for autodigestion?
A. lipase
B. elastase
C. trypsin
D. amylase
E. pepsin

73. A 26-year-old man is admitted to the Emergency Department with multiple peripheral
fractures. He is clinically shocked. Which is the structure responsible for the first hemostatic
response to a fall in systemic arterial blood pressure?
A. Adenohypophysis
B. Baroreceptor
C. Chemoreceptor
D. renin
E. Neurohypophysis

74. Failure of caudal part of metanephros to develop will result in:

A. renal agenesis
B. horseshoe kidney
C. polycystic kidney
D. ureter agenesis
E. double ureter

75. Which of the following is required to be divided during tracheostomy?

A. Anterior jugular vein
B. Thymus
C. Thyroid isthmus
D. Recurrent laryngeal
E. Ascending pharyngeal

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76. The branchial cyst is derived from which pharyngeal arch?

A. First
B. Second
C. Third
D. Fourth
E. Sixth
77. Which of the following organs has a lymphatic drainage to para-aortic LN?
A. Ovary
B. Scrotum
C. Cervix
D. Anal canal above dentate
E. Anal canal below dentate
78. What is the lymphatic drainage of anal canal below dentate line?
A. Superficial inguinal lymph nodes
B. Deep inguinal lymph nodes
C. Internal iliac lymph nodes
D. Obturator lymph nodes
E. Paraaortic lymph nodes

79. What is the lymphatic drainage of scrotum?

A. Superficial horizontal inguinal lymph nodes
B. Superficial vertical inguinal lymph nodes
C. Deep inguinal lymph nodes
D. Internal iliac lymph nodes
E. Paraaortic lymph nodes

80. What is the posterior relation of the inguinal canal?

A. external oblique aponeurosis
B. internal oblique muscle
C. rectus muscle
D. posterior rectus sheath
E. conjoint tendon and Fascia Transversalis

81. Countercurrent mechanism leading to the concentration of urine in the loop of Henle is mainly
mediated by?
A. Active transport of solute out of thin section ascending limb
B. Impermeability to water in thick ascending limb
C. Permeability to solute in descending limb
D. Permeability to solute in thick ascending limb
E. Permeability to water of thin section ascending limb

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82. A 33 years old man presented after RTA with complete transection of spinal cord but still have
bladder control due to:
A. Intact parasympathetic to external urethral sphincter
B. Intact innervation to internal sphincter
C. Intact detrusor muscle innervation
D. Intact pudendal nerve
E. None of the above

83. The surface landmarks used to localize the optimal site for a tracheostomy incision are midway
between the suprasternal notch and which of the following?
A. Cricoid
B. Hyoid
C. Mastoid
D. Laryngeal prominence
E. Thyroid

84. A 70-year-old man is admitted to hospital with a 12-hour history of a painful white leg. A
femoral artery embolus is shown on angiography. He is an insulin controlled diabetic and takes
ibuprofen for longstanding osteoarthritis. Twenty-four hours after emergency embolectomy his
blood pressure is 90/60 mmHg and he passes very dark brown urine. A dipstick shows myoglobin
and traces of blood. His blood glucose is 15 mmol/L (normal- 4.0-6.0), urea 12 mmol/L (normal
3.2-7.5) and creatinine 180 mmol/L (normal 35-110). What is the most likely cause of his
abnormal renal function?
A. Drug induced nephropathy
B. Hypovolemia
C. Methemoglobinemia
D. Rhabdomyolysis
E. Uncontrolled diabetes

85. Regarding myasthenia gravis, receptors to be affected is related to:

A. acetylcholine post synaptic cholinergic receptor
B. adrenaline
C. norepinephrine
D. dopamine
E. GABA
86. What is the first branch of internal carotid artery?
A. Ophthalmic artery
B. Anterior cerebral artery
C. Middle cerebral artery
D. Posterior cerebral artery
E. Middle meningeal artery

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87. A baby was diagnosed with tetralogy of Fallot, which of the following is associated with this
condition?
A. Pulmonary stenosis
B. ASD
C. Left ventricular hypertrophy
D. Left to right shunt
E. All of the above

88. The most common site of obstruction in hydrocephalus?

A. Foramen of Monro
B. Foramen of Luschka and Magendi
C. Cerebral aqueduct of Silvius
D. Subarachnoid space
E. None of the above

89. Site of adrenaline effect to increase heart rate is:

A. B1
B. B2
C. α1
D. α2
E. None of the above

90. Left cardiac shadow in chest x-ray is mainly composed of?

A. Left Ventricle
B. Right ventricle
C. Left atrium
D. Right atrium
E. None of the above

91. A healthy 36 years old man is being assessed with a view to be a life related kidney donor.
Which of following investigations is the most accurate for measuring the GFR?
A. Creatinine clearance
B. Glucose Clearance
C. Inulin Clearance
D. PAH
E. Urea clearance

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 MRCS I.V. Course

92. What is the main structure to be divided during Pfennensteal incision?

A. Posterior rectus sheath
B. External oblique muscle
C. Internal oblique muscle
D. Conjoint tendon
E. Rectus muscle

93. According to the UK law (or the GMC), if someone had blood transfusion before,
A. he will not be able to donate before 6 months
B. will not be able to donate before 1 year
C. will not be able to donate forever
D. will be able to donate only if his viral screening is negative
E. None of the above.

94. A patient with Cushing disease, the most common lab abnormality to be seen is:
A. hyperkalemia
B. hypokalemia
C. hyponatremia
D. hypocalcemia
E. hypomagnesemia

95. After extensive burn, a patient presented with painless abdominal distension associated with
hiccup and vomiting?
A. Curling ulcer
B. Acute gastric dilatation
C. Sepsis
D. Intestinal obstruction
E. Pancreatitis

96. A 50-year-old man with progressive cough, dyspnea and weight loss starts to complain of
polyuria. His serum calcium is high, on X-ray he has lung mass, investigation to be done is:
A. ΡΤΗ
B. 1,25 cholehydroxycalciferol
C. ACTH
D. Parathyroid hormone related peptide
E. Histamine

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 MRCS I.V. Course

97. A patient has developed iatrogenic perforation of esophagus during endoscopy session, what is
the suitable method of nutrition regarding his condition?
A. TPN
B. PEG
C. NGT
D. Jejunostomy
E. Elemental diet

98. Young Lady has many diseases prepared for surgery, which of the following scores is not
relevant in the perioperative period?
A. ASA
B. POSSUM
C. Charlson
D. APACHE
E. None of the above

99. 58-year-old woman, a known patient with thoracic right-sided meningioma, presents with
features suggestive of a Brown-Sequard syndrome. The clinical findings will include which of the
following?
A. Left sided weakness, left sided proprioception and vibration loss, right sided loss of pin
prick sensation
B. Right sided weakness, right sided proprioception, and vibration loss, left sided loss of
pin prick sensation
C. Right sided weakness, right sided proprioception and vibration loss, right sided loss of
pin prick sensation
D. Right sided weakness, left sided proprioception and vibration loss, right sided loss of pin
prick sensation
E. left sided weakness, right sided proprioception and vibration loss, left sided loss of pin
prick sensation.

100.A patient was admitted after RTA, undergone splenectomy, developed petechial rash, has low
PLT, HB, fibrinogen and high PT and APTT. What is your diagnosis?
A. DIC
B. idiopathic thrombocytopenic purpura
C. Sepsis
D. Aplastic anemia
E. Herpes zoster

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 MRCS I.V. Course

101.An Elderly man was planned for GI surgery and asked about the importance of taking
carbohydrate drink before the operation as part of enhanced recovery program
A. to reduce insulin resistance and improve nitrogen balance
B. to treatment of Addisonian crisis
C. to prevent diabetic ketoacidosis
D. to prevent hypothermia
E. none of the above

102.An Elderly man has bilateral femur shaft fracture underwent fixation, intra operative blood loss
was 800ml, after 1-hour post op he became tachypneic and then arrested:
A. Fat embolism
B. Tension pneumothorax
C. PE
D. Acute left ventricular failure
E. ARDS

103.Patient with multiple small bowel resection due to strictures, the best type of nutritional
support
A. TPN
B. NGT
C. PEG
D. Jejunostomy
E. Open gastrostomy

104.Hypospadias is a result of defect related to:

A. urogenital fold
B. urogenital tubercle
C. patent urachus
D. mesonephron
E. none of the above

105.Epispadias is a congenital anomaly:

A. Opening of urethra on anterior surface of penis
B. Opening of urethra on inferior surface of penis
C. Due to abnormal positioning of the genital tubercle
D. Associated with bladder exstrophy
E. None of the above

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 MRCS I.V. Course

106.Which of the following is a sign of anxiety before surgery?

A. Bronchodilation
B. Micturition
C. Mitosis
D. Increased peristalsis
E. None of the above

107.A child was brought by his mother due to painless fresh rectal bleeding of small amount not
associated with abdominal pain or change in abdominal habit. What is the diagnosis?
A. Intussusception
B. Juvenile polyp
C. Diverticulum
D. Anal fissure
E. None of the above

108.A patient with hypothermia 35.8C is going to elective hernia repair. What is the appropriate
management?
A. do not operate before core temperature of 36
B. intraperitoneal lavage and proceed
C. warm intra-venous fluid to the patient and proceed
D. raise temperature of the room
E. None of the above

109.A patient came after RTA with head injury, his Glasgow coma scale dropped. What are you
going to expect regarding his heart rate and blood pressure?
A. blood pressure increases, heart rate decreases
B. blood pressure increases, heart rate increases
C. blood pressure decreases, heart rate increases
D. blood pressure decreases, heart rate decreases
E. None of the above

110.which of the following reduce postoperative risk of infection?

A. Shaving immediately before operation
B. Skin sterilization with iodine
C. Theater zooning
D. Preoperative antibiotic
E. Contact Ulcer

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 MRCS I.V. Course

111.A patient with antithrombin 3 deficiency, to be treated with:

A. LMWH
B. Unfractionated heparin
C. warfarin for life
D. warfarin for 6 months
E. stocking

112.A 53 years old lady with metastasis symptoms and back pain, with hypercalcemia. What to be
administered first?
A. Prednisolone
B. 0.9% Normal Saline
C. Pamidronate
D. Zoledronate
E. I.V K supplementation

113.A man suffered a gunshot through the right 9th intercostal cartilage, the most likely organ to be
injured is:
A. Liver
B. Fundus of gall bladder
C. Body of gall bladder
D. Left Kidney
E. Pancreas

114.Parts of conducting system of heart include which of the following?

A. SA node
B. Musculi pectinati
C. AV node
D. Chorda tendenie
E. None of the above

115.Uses of PAHA (Para Amino Hipruric Acid) include which of the following?
A. estimation of renal blood flow
B. estimation of GFR
C. estimation of urine output
D. estimate the filtration fraction
E. None of the above

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 MRCS I.V. Course

116.Branchial cyst is a derivative of which arch?

A. 1st pharyngeal
B. 2nd pharyngeal
C. 3rd pharyngeal
D. 4th pharyngeal
E. 6th pharyngeal

117.Dartos muscle is layer of scrotum derived from?

A. Superficial fascial layer.
B. Cremasteric muscle
C. Internal oblique muscle
D. Peritoneum
E. External oblique muscle

118.A Pigmented gall bladder stone is mainly composed of:

A. Calcium oxalate
B. Calcium bilirubinate
C. Cholesterol
D. Bile salts
E. None of the above

119.Causes of hemolysis in splenomegaly include which of the following?

A. Destruction by splenic sinusoids (sequestration)
B. Secretion of autoimmune antibodies
C. Portal hypertension
D. Bone marrow hyperplasia
E. None of the above

120.Structure passing through the diaphragmatic opening at T12 include:

A. Azygos vein and thoracic duct
B. Vagus nerve and esophagus
C. IVC and phrenic nerve
D. Ureter and gonadal vessels
E. None of the above.
121.Which statement is true about right coronary artery origin?
A. Posterior from aorta above aortic valve
B. Anterior from aorta above aortic valve
C. Posterior from aorta below aortic valve
D. Anterior from aorta below aortic valve
E. None of the above

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 MRCS I.V. Course

122.What are the boundaries of the correct site for intercostal chest drain insertion?
A. Pectoralis major, serratus and line through the nipple
B. Pectoralis minor, serratus and line through nipple
C. Pectoralis major, latissimus dorsi and line through the nipple
D. Pectoralis minor, latissimus dorsi and line through nipple
E. None of the above

123.Support of cervix is mainly by:

A. Broad ligament
B. Ovarian ligament
C. Round ligament
D. transverse cervical ligament
E. none of the above

124.Hypothermia is identified on ECG by:

A. Delta wave
B. U wave
C. J wave
D. shortened PR
E. None of the above

125.After salivary gland surgery, salivation was impaired. What is the involved ganglion?
A. Pterygopalatine ganglion
B. Submandibular ganglion
C. Gasserian ganglion
D. Ciliary ganglion
E. None of the above

126.A 6-year-old child requires a long-term drug therapy to treat a rare genetic disorder. The drug
must be given intravenously. Recently, there have been issues with the child pulling the current
Hickman line and the parents are requesting an alternative. What is the best option?
A. Triple lumen subclavian line
B. Porta Cath device
C. Intermittent cannulation as needed
D. PICC line
E. Broviac line

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 MRCS I.V. Course

127.A patient with symptoms of rheumatoid arthritis. What is the most specific factor for his
condition?
A. ANCA
B. ANA
C. Antimitochondrial antibody
D. Antiphospholipid antibodies
E. Antimicrosomal antibody

128.A pregnant tall lady at 36-week gestation came with a sudden sharp chest pain, her father died
from MI, what is the most likely diagnosis?
A. Aortic dissection
B. Pulmonary embolism
C. Myocardial infarction
D. Pericarditis
E. None of the above

129.You are processing a clinical study on a group of 87 patient about giving IV fluids and
postoperative dehydration. It depends on reading urea and creatinine before and during
operation. The collected data was normally distributed. What is the statistical test you will use?
A. Paired T test
B. Mann Whitney U test
C. Chi-square
D. Unpaired T test
E. Wilcoxon

130.A study comparing fluid requirements in burn patient, study participants are classified to males
and female groups, most patient had small values and some larger values. Which test to apply?
A. Paired T test
B. Unpaired T test
C. Mann Whitney U test
D. Chi-square
E. None of the above

131.What is Reciprocal of absolute risk reduction?

A. Number needed to treat.
B. Relative risk reduction.
C. Odds ratio.
D. Sensitivity.
E. Probability.

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132.A 45-year-old patient presented with abdominal pain, flushing and diarrhea, underwent
appendectomy with histological finding of 4 cm carcinoid with free surgical margins. What is the
best next investigation?
A. CT scan abdomen with contrast
B. Urinary 5-HIAA
C. Abdominal USS
D. MRI Abdomen and pelvis
E. PET-Scan

133.What is the best method for Sterilization of endoscopy tools?

A. Plasma sterilization
B. Alcohol 70%
C. Glutaraldehyde
D. Gamma radiation
E. Heat Oven

134.A 52 years old smoker with large venous ulcer on her medial malleolus for around 30 years,
which of the following could be due to long-term varicose veins?
A. Dark discoloration of the toes
B. Eczema around the ankle
C. Foot ulceration
D. Amputation of toes
E. Loss of pulsation

135.A 50-year-old patient with Barrett disease for a long time, presented now complaining from 2
months history of dysphagia and weight loss, histological finding of esophagus will reveal?
A. Squamous cell carcinoma
B. Adenocarcinoma
C. Signet ring carcinoma
D. Aden squamous carcinoma
E. Columnar metaplasia

136.Male 35 years old presented with tender fluctuate perianal and rectal swelling, he is feverish
for that past 2 days and cannot tolerate PR examination. The most appropriate treatment is:
A. Incision of this swelling and primary closure
B. Excision of this swelling
C. Hemorrhoidectomy
D. Medical Treatment
E. Incision of the swelling and lay open

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137.Male patient 45 years old complained from a long history of upper abdominal pain due to
chronic use of analgesics, now he presented with sever agonizing abdominal pain and you
suspect that he has perforated duodenal ulcer. What is the best investigation modality to detect
free air in this abdomen?
A. CT Abdomen pelvis with contrast
B. CT Abdomen pelvis without contrast
C. Barium swallow
D. Erect chest-abdomen x-ray
E. Water soluble contrast

138.A 45-lady started to complain from right leg pain and swelling, after traveling from japan to UK,
her peripheral pulses are intact, ultrasound revealed a large femoral venous thrombus, what is to
be given immediately?
A. Oral Warfarin
B. IV Heparin
C. Thrombolysis
D. Aspirin
E. IVC Filter

139.A 50-year-old patient dealing with sheep presented with weight loss, hepatomegaly which is
tender on examination. MRI liver show a well round calcifications inside the liver, with
eosinophilia in FBC. What is your diagnosis?
A. HCC
B. Pyogenic liver Abscess
C. Hydatid disease of the liver
D. Cholangiocarcinoma
E. Liver Mets
140.A 65-year-old patient with ulcerative colitis complaining from peritonitis and bowel perforation.
Surgeons decide to perform an ileostomy. After 6 months he developed skin ulceration around
stoma site. what is the name of these ulcers?
A. Erythema nodosum
B. Pyoderma gangrenosum
C. Necrotizing fasciitis
D. Squamous cell carcinoma
E. Contact Ulcer
141.A 35 years old lady with recurrent episodes of RUQ colic pain, USS showed multiple small gall
stones with increase thickness of the wall with normal CBD, what to do next?
A. Elective cholecystectomy
B. MRCP
C. Urgent cholecystectomy
D. Liver function tests
E. ERCP

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142.8-year-old boy with chronic constipation for a long period and he presented now complaining
from a very agonizing pain from the anus associated with brisk fresh blood at the end of
defecation, what is your provisional diagnosis?
A. Juvenile polyp
B. Anal Hemorrhoids
C. Intussusception
D. Anal fissure
E. Perianal abscess

143.A 50-year-old woman presents with a history of right upper quadrant pain and jaundice which
is progressive and unremitting. She reports that her urine was dark in color and that her stools
are offensive and difficult to flush. By examination she has a palpable mass in the right upper
quadrant region. Which of the following is the most likely diagnosis?
A. Chronic calcular cholecystitis
B. Primary biliary cirrhosis
C. Gallbladder abscess
D. Carcinoma head of pancreas
E. CBD stones

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Notes

Anatomy Recalls 31 MRCS I.V. Course