MRCS part A- September, 2018 exam

1 .a woman have a routine gynecological check what is palpated anterior

to the cervix on vaginal examination- Base of Bladder

2. Male versus female pelvis- Female pelvis wider-

3. Ischiorectal abscess scenario- Alcocks canal lies laterally

4. A 70 old man have multiple profuse urination every time he goes to

toilet and after finish he has the same sensation to urinate with a large
amount - bladder diverticulum

5. A man that wanted to go to the toilet and after a time Bladder rupture
of exposure to stress he didn’t want any more with coming to the
emergency by abdominal distention and the Foley catheter is empty

6. The max point of resistance while you put urinary catheter,

membranous

7. A patient is noticed that he is confused after TURP operation-

hyponatremia

8. Sensory deficit anterior thigh and with inability to extend the knee post
hernia repair- femoral nerve injury

9. Layer of abdomen after retraction of rectus abdominis muscle in a

pfannenstiel incision

10. Groin mass in a child appears during the day time and disappear
during the night path- patent process vaginalis

11. A patient diagnosed that he has a herpes zoster complaining of pain

what is from the following at the same dermatome -angle of mouth

12. Posterior relation of the kidney.. Psoas muscle

13. Psoas muscle question the answer was about its origin- T12-L5 body

14. Anterior relationship of head of pancreas- pylorus

15. Anterior surface gastric ulcer between the antrum and the body of
stomach -Rt gastroepiploic
16. A 63 year old man who smokes heavily presents with dyspepsia. he is
tested and found to be positive for helicobacter pylori infection. one
evening he has an episode of haematemesis and collapses. what is the
most likely vessel to be responsible? Gastroduodenal

17. What is the most part of the following is susceptible to colonic

ischemia -splenic flexure

18. A stroke affecting left lower extremity- Ant cerebral

19. A case of dysarthria and wheel barrow effect of tongue on one side-
hypoglossal nerve injury

20. Vitamin deficiency in alcoholic has manifestations of wernickes

ataxia cardiomyopathy- thiamine

21. Vitamin deficiency with night blindness- vitamin A

22. Trauma to face affecting orbit with periorbital hematoma and

subconjunctival hemorrhage and epistaxis the fracture site … naso
ethmoidal

23. Parotid mass causing facial nerve deficit manifestations.. adenoid

cystic carcinoma

24. 35 yrs old female on the routine mammogram has intermediate

microcalcification and the mammo was negative 3 years ago with no
lymph node ductal ca-DCIS

25. Female on warfarin and has to make further investigation after the
triple check the choices was needle and cor and other invasive and the
last choice was MRI

26. Which hormone increases pancreatic secretion rich in bicarbonate-

Secretin

27. Zenker diverticulum site in pharynx -between sup and inf constrictors

28. Increased PT APTT decrease platelet ..DIC

29. Patient with congenital antithrombin3 came to do lt hemi what will u

prescribe for her postop -warfarin for life )

30. Target INR for warfarin 2:3

31. A scenario about ECG absent p wave- atrial fibrillation

3 analgesia questions

32. One did open cholecystectomy

33. One has mid thoracic back pain from breast caner

34. One has brain metastasis from lung and have headache

35. Ventricular repolarization which wave? T wave

36. Which diuretic acts on Na/k+ channel in collecting duct and causes
hyperkalemia (spironolactone)

37. Creatinine clearance used to measure what?? GFR

38. Scenario of shock with bradycardia and decreased cardiac output and
decreased SVR

39. Tachycardia and decreased svr and increase internal jugular vein
pressure

40. Renin acts on which one of the following- angiotensinogen

41. Diarrhea causing metabolic acidosis is due to loss of what? loss of

HCO3

42. Scenario of a man has a scrotal pain after vasectomy and during check
they found sperm granuloma

43. Scenario of torsion testicular appendages-

44. dre palpate 4 cm from anal verge posterolateral what will u find -
seminal vesicles)

45. testicular mass in 20 yrs old guy had a trauma since 3 weeks and
supraclavicular LN - lymphoma

46,47,48 .. 3 questions of limping of limb-DX was- Perthe’s disease,

DDH, Telepse

49. Scenario of pain 1 week ago causing limp – tenderness over 2nd
metatarsal which unusually thick march # ..
50. Scenario of sharp pain over the foot dorsum radiates to toe and
tenderness in a cleft between 3rd and 4th toe morton's neuroma

51. A question about a trauma to the knee which became rigidly flexed
knee at 30 degree trying to flex or extend knee refused by the patient and
he mentioned giving away (acl-loose body- dislocated patella )

52. Case scenario of med collateral lig injury-pain localized

53. A case of ligamentous/ soft tissue ankle injury..no fracture seen in

xray …mri

54. Intraarticular# elbow joint and preparation for surgery ….CT scan

55. Scenario about painful arc in shoulder which muscle affected

(supraspinatus)

56. Scenario about difficult abduction at 1st then he can abduct normally
after certain angle supraspinatus tendon tear

57. Patient cannot elevate his arm above certain angle to above his head
and cannot shrug his shoulders after posterior triangle maneuver what the
nerve affected- accessory nerve

58. Case scenario about manifestation of rt cerebellar lesion

59. Case scenario - lateral geniculate body

60. a case scenario of a patient localize to pain – make sounds- open eye
to pain GCS score 5+2+2= 9

61. Injury to oculomotor nerve in extradural hematoma scenario

62. Tempromandibular joint dislocation and the patient has severe pain
around the joint what is the nerve? auriculotemporal

63. Scenario about maxillary sinusitis and relationship to upper tooth as a

source of infection

64. Scenario of mastoid process infection with pus can cause destruction
of which of the following (inner ear-sigmoid sinus – occipital-mandibular
–int carotid )
65. Scenario of recurrent gastric and duodenal ulcers with succession
splash …. Pyloric stenosis

66. Bochdalek hernia due to failure of left pleuroperitoneal membrane

closure

67. 10 months with recurrent chest infection, cough at night awake hip
from sleep besides loosing wait (reflux –asthma –tracheoesophageal
fistula)

68. 10 years old girl with bloody diarrhea … inflammatory bowel disease

69. 8 years girl with fever and abd pain no pelvic tenderness DRE..
dipstick is normal no tenderness (nonspecific abdominal pain )

70. 1 day bilious vomiting and scaphoid abdomen (Duodenal atresia)

71. a very week girl with non-bilious vomiting at the 5th week of birth
CHPS (congenital Hypertrophic Pyloric Stenosis)

72. 10 months boy is screaming with passing dark blood with abdominal
mass in examination with free DRE- intussusception

73. Patient has solitary vertebral mass can cause respiratory compromise
on which level –cricoid

74. Patient has prostatic malignancy and asked about the route of
transmission to the vertebrae- vertebral venous plexus

75. Melanoma prognostic factor? Breslow classification

76. Tumor marker for malignant melanoma- non of the above

77. Ulcer lateral border of tongue with cervical lymphadenopathy- scc

78. velvety like lesion of the tongue- Erythroplasia

79. Neck rubbery mass with axillary and inguinal masses (lymphoma )

80. Scrotum skin lymphatic drainage- superficial inguinal lymph node

81. Structure affected in superficial part of submandibular gland excision-

marginal mandibular nerve

82. Asymmetric smile which nerve is affected?- facial nerve

83. Right coronary artery is coming from (post ascending

84. SA node .. Receives innervation from vagus

85. Rt ventricle related to the diaphragm

86. Widened mediastinum because of trauma to ascending aorta rupture

87. Patient with acute pancreatitis and pulmonary white infiltrates ARDS

88. Ventilation type question- pulmonary ventilation – 5-6 liter/minute

89. Patient with a trauma to chest with fracture rib air fluid level in x-ray
what to do ? Chest tube

90. A case of tension pneumothorax description scenario with mediastinal

shift in emergency what to to do needle in 2nd intercostal space

91. Posterior right rib fracture at the angle of t8 inward cause injury of ?
Rt lower lung

92. A case of cardiac tamponade- Beck’s triad(hypotension, raised JVP,

muffled heart sound)

93. Lung mass with cavitation -SCC

94. Lung mass with a flat cells with keratin … SCC

95. Apical lung scenario about tb infection

96. A smoker with squamous cell in his sputum … reversible metaplasia

97. Esophageal varices question asked about the vessel- Left gastric

98. A case scenario about the type of necrosis in (acute) pancreatitis in a

young patient has (spots) in x-ray - fat necrosis

99. A case scenario about destroyed popliteal artery and tibial nerve with
soft tissue amputation

100. A case about acute appendicitis after 24 hours … predominant cell-

neutrophils

101. Case about epitheloid and macrophages

102. Patient underwent orif bimalleolar fixation, and below knee cast then
developed inability to dorsiflex his ankle and paraesthesia along the
dorsum of the foot - common peroneal nerve injury

103. Posterior relation to lateral malleolus- peroneus longus

104. Sural (s1,2) nerve injury- minor deficit- used for grafting

105. Saphenous nerve (branch of femoral nerve) injury-loss of cutaneous

sensation of medial leg.

106. Sciatic injury in post hip approach

107. Deep peroneal nerve injury and asking about the sensory area 1st
web space

108. Contents of post mediastinum all except . body of vertebrae –

splanchnic nerves to heart – aorta - ..thoracic duct

109. A case of solitary thyroid nodule 2 cm with papillary in fnac with no

ln in us (hemi or total)

110. Medullary carcinoma management- total thyroidectomy and

radiotherapy

111. a case of Pheochromocytoma

112. a case of follicular carcinoma with metastasis to bone

113. a table of high ca high po4 high PTH and high urea and creatinine-
tertiary

114. a case scenario about which type of tumor is much causing-

microcytic anemia

115. a patient has anal incontinence after childbirth what to do?

Manometry

116. a patient have loop colostomy for emergency obstructing rectal

tumor came to do revision and ant resection and what to do for leak check
(water soluble contrast )

117. A case of cerebral perfusion pressure: bl pr is 110/80 and icp is 18

….72 mmhg (mean pressure minus icp)
118. A case of burn in 70 kg patient with 50% surface area affection what
is the fluid requirements during the 24 hrs … 14 litre

119. a patient had mid esophageal tumor resection what is the nutrition
possible for him- feeding jejunostomy

120. a patient will do hemorrhoids and his hb is 9 he put in a list after 6

weeks how would u give him supplement -oral iron

121. A patient has injury to cubital fossa the brachial artery is lateral to
median

122. Where is the level of injury in a hand with claw at little and ring
with interosseous wasting – hypothesia of the little and ring fingers and
dorsal sensation is intact- ulnar nerve injury

123. Ulnar compression at wrist- weakness in little finger

124. A patient has a week grip and while she is trying to hold a knife her
hand flexes with adductor pollicis weakness -ulnar nerve

125. A patient had an injury and now he has flexed little and ring he can
flex it normally but can’t extend it- fasciotomy release trigger finger

126. A child has got a water burn (scald) covering whole dorsal forearm
with erythema and blisters (1st degree) what the management -conserve
without covering

127. Skin incision for evacuation of an abscess and after healing scar
overgrowth and a mass rapidly growing and painful formed, the skin is
immobile over lesion - dermatofibroma

128. First compensatory measures in hypothermia through? hypothalamus

129. First compensatory measures in shock baroreceptor stimulation –

sympathetic stimulation

130. A drug used in induction anesthesia in shock for a patient came in

trauma -ketamine

131. Isoprenaline has an inotropic effect through –beta 1

132. Local anesthesia is give for biers block to a “fracture” prilocaine

only
133. Lignocaine common side effect … cardiotoxicity

134. Depolarizing muscle relaxant- suxamethonium

135. A question was a bout post-operative rapid recovery in a hip surgery

patient all is right- good analgesia

136. Cori cycle in which cell -hepatocytes

137. a question asking about mode of action of botulin toxin- ach release
block in nerve endings of spinal cord..

138. What is the cause of hemorrhagic pancreatitis- trypsin

139. Patient with a past history of diabetes and AF and come with sudden
loss of distal pulsation below knee - embolus

140. Patient with post thrombotic syndrome asking about management-

elevation, compression, pentoxyphylline

141. 60 yrs old patient came to the hospital with a fever and abdominal
pain after discharge 3 days a go for a lap chole he has a leak from the
cystic and made ERCP with stent what is the diagnosis ? Acute
cholangitis

142. The ampulla of Vater site in the- 2nd part duodenum postero medial

143. A patient with hypercapnia and hypoxia … type 2 respiratory failure

144. Nasopharyngeal carcinoma what is the virus- EBV

145. A question about post-transplant infection …CMV

146. Inferior parathyroid gland originate from? 3rd pharyngeal pouch

147. Brown sequard and tracts affections- same side all motor loss,
opposite pain & temperature

148. A patient with high fasting and 2hr pp glucose intolerance …. dm

149. A question about vertebral artery course- from subclavian artery, c6

to foramen magnum, then midline basilar artery

150. Higher control of autonomic nervous system- hypothalamus

151. Spinal trauma and spasticity with hyperreflexia-upper motor lesion

152. A case of persistent fistula and distal ileum affection … Crohn’s
disease

153. 40 years old patient within 3 hours after sub capsular fracture -
hemiarthroplasty

154. A child come with manifestation of Down syndrome and can

understand the appendectomy operation and consequences consent from
parents

155. A child came hemodynamically unstable and shocked after trauma-

proceed without consent

156. A scenario about a study made on a group of people 87 about giving

a fluids and postoperative dehydration it was reading of urea and
creatinine before and during operation and distribution is normal -paired
t test

157. Lumber puncture- level of iliac crest

158. Anterior relation of femoral hernia neck- inguinal ligament

159. Inferior epigastric vein drain in –external iliac vein-

160. Hassels corpuscles.. Thymoma

161. Calf claudication level of obstruction -popliteal

162. The cause of decrease coronary perfusion- Decrease Dystolic

Interval

163. Thyroid scenario with pathology bland cells- cd 20 b phenotype

164. Antiphospholipid syndrome case scenario-hypercoagubility,

miscarriage, anti cadiolipin, lupus antibody-

165. 18 years old girl with amenorrhea and abdominal pain what to do 1st
? B-hcg

166. a case of esophageal rupture in a patient had severe vomiting and he

has upper abdominal pain and subcutaneous crepitus

167. Fournier gangrene in perineum and extension of necrotic tissue to

the groin what is the bacteria …. Mixed aerobe and anaerobe
168. Empiric antibiotic in a patient came by infected wound after GIT
operation- quinolone and metro

169. A pancreatic cancer with liver metastasis with jaundice. ERCP and
stenting

170. An esophageal cancer with metastasis- stent and run

171. Child with open fracture tibia in tibia with- external fixator

172. Tibial fracture and bared area- split thickness graft

173. Scalp laceration with particles inside the wound and dirty edge –
bleeding from emissary vein-

174. Occupational disease of exposure to PVC- Angiosarcoma liver

175. Follow up after thyroidectomy … thyroglobulin

176. Inslinoma question high insulin- high c-peptide

177. A question about vaginorectal fistula and asking for the

embryological cause- breakdown of the cloacal membrane covering this
area provides communication to the exterior for the anus and urogenital
sinus. Abnormalities in the size of the posterior region of the cloaca shift
the entrance of the anus anteriorly, causing rectovaginal and recto
urethral fistulas and atresia.
178. Unilateral cleft lip embryology- no fusion of maxillary prominence
with frontonasal prominence

179. Ulnar artery and nerve in the wrist-ulnar artery deeper and medially

180. A scenario of old woman and upper lateral quadrant mass …

invasive ductal carcinoma

181. TNM classification of colon cancer in the submucosa and not invade
the muscularis mucosa and 2 nodes out of 24 with no metastasis-
t1n1bm0

182. A case of central disc prolapse with lower motor neuron lesion
manifestation (cauda equine syndrome- bowel bladder function loss

183. Phases in duplex-arterial phase, venous phase

184. Ruptured tendon Achilles- Simmonds test

185. 24 hour colicky pain and bloody diarrhea after eating barbecued
chicken -salmonella typhi

186. A case of superficial temporal artery - giant cell arteritis

187. Osteomyelitis in sickle cell disease -salmonella

188. A Caucasian guy with jaundice gall bladder multiple stones –

splenomegaly and anemia. Congenital spherocytosis

189. What is associated with ulcerative colitis (Primary biliary cirrhosis

–sclerosing cholangitis

190. A patient with gout disease and we did joint aspiration and we find
under the microscope -needle shaped crystals and negative birefringence

191. About tourniquet using in operation- inflation of cuff above mean n

before exsanguination

192. What is the least reliable sign of compartment syndrome - loss of

pedal pulse?

193. Adrenal hormones and its effect on Na and k+- hypernatremia &
hypokalemia

194. A patient recently come from Bangladesh –hepatitis a- and

pulmonary tb

195. MRSA carrier in nose patient come to the hospital for surgery what
u gonna give him -iv vancomycin

196. Scenario about infection with painless dark black eschar -bacillus
anthracis

197. the most important structure that supports the uterus - central
perineal muscle

198. A case of steatorrhea due to gastrinoma what is the cause -decrease

lipase activity

199. Increase gastrin secretion cause-zollinger ellison syndrome

200. Mechanism of conserving water after hypovolemic shock –
contraction of efferent arteriole

201. A wound with dirty odor and crepitation in the wound what is
empiric ab till the result of swap appear- gas gangrene

202. Arnold chiari malformation which tracts affected – spinocerebellar

tract

203. A biopsy specimen using Prussian blue stain to detect what? Iron

204. Treatment of hypocalcaemia -calcium gluconate

205. Very long scenario referred to rhabdomyolysis due to burn or RTA

and there was cloudy brown urine and high potassium what will u give
him. – dialysis/diuretics- furosemide

206. The layer divided in herniotomy in a 6 yrs old child -external

oblique

207. Cremasteric muscle derived from which ant abdominal wall layer-
internal oblique

208. After clamping the umbilical cord what will not give oxygenated
blood to the embryo any more ductus venosus

209. Torticollis which nerve responsible for muscle which causing this-
spinal accessory?

210. a patient who has pulsatile intraabdominal aneurysm related to

vessels at level of greater trochanter - external iliac artery

Dr. Sayed Sujon