2013

Recalls

September 2013 MRCS I.V.

 MRCS I.V. Course

Sep 2013
1. Radial head articulates with:
A. Olecranon
B. Trochlea
C. Ulnar head
D. Capitulum
E. None of the above

2. Which ligament (of the proximal radioulnar joint) keeps the radial head in place?
A. Annular ligament
B. Lacunar ligament
C. Interosseus membrane
D. Plantar ligament
E. None of the above

3. A 32 years old patient came at A& E with swelling and pain at mid-thigh. On examination, his foot
is internally rotated with absent dorsalis pedis pulse. What is the most likely cause?
A. Anterior hip dislocation
B. Posterior hip dislocation
C. Fracture neck of femur
D. Fracture femoral shaft
E. None of the above

4. Which nerve is involved in Distal femur approach?

A. Sural nerve
B. Tibial nerve
C. Common peroneal nerve
D. Saphenous nerve
E. Sciatic nerve

5. Which nerve is involved in posterior approach hip?

A. Pudendal nerve
B. Genitofemoral nerve
C. Common peroneal nerve
D. Obturator nerve
E. Sciatic nerve

6. Which nerve is involved in medial approach ankle?

A. Sural nerve
B. Tibial nerve
C. Common peroneal nerve
D. Saphenous nerve
E. Sciatic nerve

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7. Which nerve is involved in mid humerus fracture?

A. Median nerve
B. Radial nerve
C. Ulnar nerve
D. Posterior interosseus nerve
E. Anterior interosseus nerve
8. A 23 years old man had a tibial fixation after fracture. He is now complaining of severe pain on
toe extension. Which nerve is likely affected?
A. Tibial nerve
B. Common peroneal nerve
C. Deep peroneal nerve
D. Superficial peroneal nerve
E. Sural nerve

9. A 70-year-old women is recovering after elective hip replacement when she complained of
spontaneous urinary retention. What is the most likely cause?
A. Bladder stone
B. Ureteric stone
C. Bladder neck inactivity
D. Urethral stricture
E. Underactive bladder
10. A 45 years old man presented with urine retention. He reported passage of pus through urethra
3 months ago. What is the most likely cause?
A. Bladder stone
B. Ureteric stone
C. Bladder neck inactivity
D. Urethral stricture
E. Underactive bladder

11. A 53 years old female presented with spontaneous fractures on minimal trauma. Her laboratory
investigations would probably show:
Alkaline phosphatase Calcium Phosphorus
A ↑ Normal Normal
B ↓ ↑ ↑
C Normal Normal Normal
D ↑ ↑ ↑
E ↓ ↓ ↓

12. A 56 years old patient with metastatic cancer is presented with lytic bone lesion on Xray. Which
of the following lab finding would be expected?
A. Hypocalcemia
B. Normocalcemia
C. Hypercalcemia
D. Hypophosphatemia
E. None of the above

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13. An 11 years old boy is brought by his mother with severe scrotal pain. Testes are not palpable
with absent cremasteric reflex. What is the appropriate treatment?
A. Scrotal Doppler
B. Immediate Orchiectomy
C. Antibiotics and follow up
D. Immediate scrotal exploration
E. Ladd’s operation

14. A 3 years old boy is brought by his mother with a hemiscrotal occasional swelling. It disappears
on lying down. What is the most probably cause?
A. Undescended testis
B. Patent processus vaginalis
C. Testicular agenesis
D. Saphena varix
E. None of the above

15. An 11 years old boy presented with sudden attack of right testicular pain. On examination,
there is tenderness over a point on the pole of the testis. What is the most likely diagnosis?
A. Torsion testis
B. Hematocele
C. Caricocele
D. Torsion of Morgagni cyst
E. Epidydimoorchitis

16. A 53 years old women sustained a needle injury while stitching. 24 hours later, there is swelling,
redness and radiating streaks around the site of puncture. What is the most likely cause?
A. Streptococcus viridans
B. Staphylococcus aureus
C. Staphylococcus epidermides
D. Streptococcus pyogenes
E. Bacteroides

17. A microbiologist reported a recurrent infection in catheterized patients in the same ward. What
is the most likely causative organism?
A. Streptococcus viridans
B. pseudomonas
C. Staphylococcus epidermides
D. Streptococcus pyogenes
E. Bacteroides

18. Hospital staffs are mainly carriers for:

A. Staphylococcus aureus
B. Streptococcus pyogenes
C. E.coli
D. Bacteroides
E. None of the above

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19. A 45 years old female is presented with knee pain. Gout is diagnosed. What is the expected
finding of joint aspirate?
A. Positive birefringent crystals
B. Negative birefringent crystals
C. Rhomboid shaped crystals
D. Ca pyrophosphate crystals
E. None of the above

20. A 53 years old woman presented with left knee pain. Xray shows a radiolucent lesion at
diaphysis of the femur extending to joint line. What is the most likely diagnosis?
A. Ewing sarcoma
B. Giant cell tumor
C. Osteosarcoma
D. Osteoid osteoma
E. None of the above

21. A 55 years old women finds pain and tingling sensation along her left wrist and forearm
especially after work. What is the appropriate treatment?
A. Fasciotomy
B. Flexor retinaculum release
C. Oral steroids
D. Casting
E. None of the above

22. Which of the following is an extensor of hip joint?

A. Psoas major muscle
B. Quadriceps femoris
C. Biceps femoris
D. Gracilis
E. Semitendinosus

23. A 53 years old man presented with weight loss and generalized fatigue. Investigations revealed
a TLC of 6x1000, Platelets 214,000 and hemoglobin 18.8. What is the most likely cause?
A. Bronchogenic carcinoma
B. Prostatic cancer
C. Bladder cancer
D. Renal cell carcinoma
E. Pancreatic carcinoma

24. Which spinal root is responsible for ankle reflex?

A. L1L2,L3
B. L5,S1,S2
C. S2,S3,S4
D. L3,L4,L5
E. None of the above

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25. A 43 years old man presented with a testicular swelling. Pathology showed uniform cells with
lymphocytic infiltration. Blood investigations revealed normal BHCG and AFP. What is the most
likely cause?
A. Classical seminoma
B. Choriocarcinoma
C. Teratoma
D. Spermatocytic seminoma
E. None of the above

26. A renal transplant patient described complaining from recurrent abdominal pain with bone pain
and he mentioned that he had had multiple fractures in the last period his investigations showing
High calcium, low phosphate, high alkaline phosphate. What is the diagnosis?
A. Tertiary hyperparathyroidism
B. Secondary hyperparathyroidism
C. Primary hyperparathyroidism
D. Increase vitamin D
E. None of the above

27. A 27 years old patient brought to ER after RTA presented with muffled heart sounds, his blood
pressure 90/60 and increased JVP what is the most probably cause of this condition?
A. Cardiac Tamponade
B. Hemothorax
C. Pneumothorax
D. Diaphragmatic rupture
E. None of the above

28. What is the Breast cancer tumor marker?

A. BRCA 1
B. CA 15-3
C. Alfa fetoprotein
D. BHCG
E. None of the above
29. What is the colorectal cancer tumor marker?
A. BRCA 1
B. CEA
C. Alfa fetoprotein
D. BHCG
E. None of the above

30. A 45-year-old lady has recently undergone a thyroidectomy for treatment of medullary thyroid
cancer. Which of the following tumour markers is used clinically to screen for recurrence?
A. Free T3
B. Thyroglobulin
C. Calcitonin
D. Free T4
E. Thyroid stimulating hormone

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31. A 56-year-old man presents with symptoms of nasal pain, anosmia and rhinorrhea with pain in
his eyeball. He has been well until recently and has worked as a wood carver for many years.
A. Ethmoid sinus cancer
B. Maxillary sinus cancer
C. Nasal polyps
D. Ethmoidal sinusitis
E. Maxillary sinusitis

32. A week after surgical elevation of the zygomatic arch a 19 year old man returns with hearing
loss vertigo and clear fluid exuding from the external auditory meatus?
A. Belly palsy
B. Cholesteatoma
C. Sarcoidosis
D. Petrous temporal bone fracture
E. Herpes zoster infection

33. A child is brought to casualty complaining of a headache and a sensation of pressure between
the eyes. On examination she is febrile with a smooth swelling overlying the superomedial aspect
of the right eye. The eye is uncomfortable and there is a purulent discharge from the inner
canthus. What is the likely diagnosis?
A. Ethmoid sinus cancer
B. Maxillary sinus cancer
C. Nasal polyps
D. Ethmoidal sinusitis
E. Maxillary sinusitis

34. A 4-year-old child is brought to the clinic by his father. They are concerned because the child
has been noted to have a small epithelial defect anterior to the left ear and is has been noted to
discharge foul smelling material for the past 2 days. What is the diagnosis?
A. Acoustic neuroma
B. Preauricular sinus
C. Acute suppurative otitis media
D. Cholesteatoma
E. Otitis externa

35. A 23 years old male patient planned for skin grafting after burn in his hand months ago. What is
the type of this graft?
A. Isograft,
B. Xenograft
C. Autograft
D. Allograft
E. heterograft

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36. A 50-year-old women presents with a diffuse swelling in the region of her right parotid together
with facial pain. On examination she has a right sided facial nerve palsy what is the cause?
A. Pleomorphic adenoma
B. Adenoid cystic carcinoma
C. Sarcoid
D. Sjogren's syndrome
E. Sialolithiasis

37. A 60 years old patient admitted in your HDU after total colectomy operation, you noticed that
he became Hypoxic after subclavian central venous line insertion, what is the probable Cause?
A. Tension pneumothorax
B. Pneumothorax
C. Subclavian artery injury
D. Cardiac tamponade
E. None of the above

38. A 38-year-old man in end-stage renal failure resulting from polycystic kidney disease receives a
cadaveric renal transplant. Good renal function is established but four weeks later deteriorates,
the serum creatinine rising by 25%. Which of the following processes is most likely to be
responsible for this deterioration?
A. B-cell mediated rejection
B. Circulating immune complex disease
C. IgG antibody mediated rejection
D. Post-transplant lymphoproliferative disorder
E. T-cell mediated rejection

39. A 62-year-old woman presents with a firm irregular mass in the upper outer quadrant of the
right breast. This appears malignant on mammography, and fine needle aspiration cytology is
reported as Cancer. Which is the first lymph node to which the tumor is most likely to
metastasis?
A. Initial node
B. Primary node
C. Secondary node
D. Sentinel node
E. Virchow's node

40. A Female patient 33 years presented with suspected mass on the right UOQ in her left breast
she reported a history of breast implants with positive family history of cancer breast what is the
best investigation for diagnosis:
A. FNAC
B. U/S
C. MRI
D. Core Biopsy
E. None of the above

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41. A 45-lady presented with RUOQ 3 cm mass appear irregular in shape in U/S. The best
investigation for her is:
A. FNAC
B. Extensional biopsy
C. MRI
D. Core Biopsy
E. None of the above

42. A 26-year-old woman presents with severe headache, photophobia, and neck stiffness. Among
other investigations, a lumbar puncture is earned out and cerebrospinal fluid is sent for
microscopy and culture. Culture shows a growth of Neisseria meningitidis. What is likely to be
the predominant-cell type in the cerebrospinal Fluid?
A. Basophils
B. Eosinophils
C. Lymphocytes
D. Macrophages
E. Neutrophils

43. A 34-year-old man presents to the surgical clinic 8 months following a laparotomy for a
ruptured spleen. He complains of a nodule in the center of his laparotomy wound. This is
explored surgically, and a stitch granuloma is found and excised. From which of the following cell
types do granulomata arise?
A. Polymorph nucleocytes
B. Plasma cells
C. Reed- Sternberg cells
D. Platelets
E. Macrophages

44. 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
45. 70-year-old man presented with bilateral parotid swelling with bilateral inability to show his
teeth or elevate his eyebrow in both side which reveled bilateral nerve facial nerve involved what
is your diagnosis?
A. Sjogren syndrome
B. HIV infection
C. Warthin tumor
D. Sarcoidosis
E. T.B

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46. Female with abdominal pain and skin rash which resolved x ray showed hilar lesions and her
investigation Ca high with decreased urea and creatinine and decreased PTH. What is your
diagnosis?
A. Sarcoidosis.
B. Lung cancer.
C. Secondary.
D. primary hyperparathyroidism.
E. None of the above

47. A 21-year-old man fractures his ulna and radius. He is treated by means of a plaster cast, which
is removed after four weeks. What pathological process is most likely to have affected the
immobilized muscles?
A. Aplasia
B. Atrophy
C. Hyperplasia
D. Hypertrophy
E. Neoplasia

48. A 5-year boy his mouther brings him to pediatric surgery clinic complaining from bilateral
gynecomastia his examination revealed atrophied both testes with absent vas deferens what is
the most suggestive cause of gynecomastia?
A. Kartagner’s syndrome
B. Sipple syndrome
C. Down syndrome
D. Klinefelter
E. None of the above

49. A 65 years old man came to your clinic presented with unilateral gynecomastia, irregular
swelling in his testis and unintentional weight loss his CT abdomen showing liver nodule?
A. Testicular tumor
B. Testicular lymphoma
C. Liver cell Failure
D. HCC
E. None of the above

50. A 55 years old complained from benign esophageal stricture and managed by placing
esophageal stent a 2 years ago. And now he presented with dysphagia and retrosternal pain
what is the most accepted diagnosis
A. Infection on the stent
B. The patient develop malignancy
C. Bolus Impaction
D. Stent migration
E. None of the above

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51. Which of the ABPI measurements shown below is most likely to be found in a 45-year-old man
who develops calf pain after walking 600 yards. It resolves during periods of rest.
A. >1.2
B. 1.0
C. 0.5
D. 0.3
E. None of the above

52. Which of the ABPI measurements shown below is most likely to be found in a 45-year-old man
who develops calf pain after walking 600 yards? He is also complaining from a rest pain.
A. >1.2
B. 1.0
C. 0.7
D. 0.5
E. 0.3

53. Which of the ABPI measurements shown below is most likely to be developed in a 15 years
history of DM and began to complain from calf pain after walking 600 yards?
A. >1.2
B. 1.0
C. 0.7
D. 0.5
E. 0.3
54. What is Reciprocal of absolute risk reduction?
A. Number needed to treat.
B. Relative risk reduction.
C. Odds ratio.
D. Sensitivity.
E. Probability.

55. Which of the following statistical tests is used to test the ability of a screening test to detect the
proportion of test positive patients from all patient?
A. Sensitivity
B. Speficitcity
C. Number needed to treat
D. Relative risk calculation
E. Odds ratio

56. A 55-year-old male presents with to ER complain from absolute constipation and persistent
vomiting for the past 2 days. His investigation showed HB of 7 mg and a mass on the Caecum
with dilatation of the small bowel up to 4 cm in diameter. What is the beat action?
A. Elective Right Hemicolectomy
B. Urgent laparotomy, Right Hemicolectomy, and ileostomy
C. Only Ileostomy
D. Urgent laparotomy and Right Hemicolectomy
E. Support general condition and refer to Chemoradiotherapy

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57. A 46-year-old lady presents with symptoms of diarrhea, weight loss of 10 Kg and a skin rash of
erythematous blisters involving the abdomen and buttocks. The blisters have an irregular border
and both intact and ruptured vesicles. What is the most likely diagnosis?
A. Colonic adenocarcinoma
B. Pancreatic adenocarcinoma
C. Tropical sprue
D. Glucagonoma
E. Insulinoma

58. What is the best sterilizing method for Orthoscopy?

A. Autoclave
B. Gamma irradiation
C. Alcohol 70%
D. Glutaraldehyde
E. Water and soap

59. You are proceeding for a femoropopliteal bypass surgery what is the best material used for
anastomosis?
A. Prolene
B. PDS
C. Vicarly
D. Silk
E. None of the above

60. A 30-year-old woman presents to the outpatient' clinic with a three-month history of diarrhea,
which is intermittently bloody. On rectal biopsy, the histology has shown' a granulomatous
inflammation. What is the most likely diagnosis?
A. Amoebiasis
B. Crohn's disease
C. Sarcoidosis
D. Tuberculosis
E. Ulcerative colitis

61. A 62-year-old man required a partial gastrectomy for a large benign ulcer in his gastric antrum.
When he is reviewed in clinic, six months later he complains of palpitations, weakness and
sweating along with a cramp-like abdominal pain which occurs within an hour of eating n meal.
Usually, he must lie down for 30-40 minutes until the symptoms subside. What is the most likely
cause of his symptom pattern?
A. Chronic gastroparesis
B. Dumping syndrome
C. Delayed gastric emptying
D. Gastroesophageal reflux
E. Recurrent ulceration

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62. A 72-year-old man presents with dysphagia. He is investigated and found to have an
adenocarcinoma of the distal esophagus. His staging investigations have revealed a solitary
metastatic lesion in the right lobe of his liver.
A. Trans hiatal Oesophagectomy
B. Ivor Lewis Oesophagectomy
C. Endoscopic sub mucosal dissection
D. Photodynamic therapy
E. Insertion of oesophageal stent

63. Smoker 68 years, with bilateral lymph node enlargement on the neck anterior to
sternomastoid, what is the cause of these lymphadenopathy?
A. tongue cancer
B. papillary thyroid cancer
C. basal cell cancer
D. follicular cell cancer
E. none of the above

64. Heparin intoxication cause which abnormality?

A. hyperkalemia
B. hypokalemia
C. Hypocalcemia
D. Hypercalcemia
E. Hyponatremia

65. What is the muscle derived from the 2nd brachial arch?
A. Mandibular of trigeminal
B. Facial
C. Glossopharyngeal
D. Superior laryngeal
E. Recurrent laryngeal

66. A person was found having left SVC thrombus. Where does it drain?
A. Portal vein,
B. oblique sinus,
C. coronary sinus
D. azygos vein,
E. internal thoracic vein

67. Male patient presented by angular cheilosis, what is the vitamin deficiency?
A. vitamin B2
B. vitamin B12
C. vitamin B1
D. Vitamin C
E. Vitamin K

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68. A neonate with urinary retention. Diagnosis is:

A. PUJ obstruction
B. Ureteric regurgure
C. Posterior urethral valve
D. Bladder cancer
E. Urethral stenosis

69. All are contents of the posterior mediastinum except:

A. Vagus nerve
B. Thoracic duct
C. Azygous vein
D. Aorta
E. Vertebra body

70. A young girl with murmur at left 2nd intercostals space. What is the affected structure?
A. Aortic valve
B. Pulmonary valve
C. Mitral valve
D. ASD
E. PDA

71. A painful small ulcer inside inner lip appears during the period of exam and stayed for week.
What is the appropriate diagnosis?
A. aphthous ulcer
B. traumatic ulcer
C. malignant ulcer
D. erythroplakia
E. leukoplakia

72. A 38 years old female 24 hours after cholecystectomy complains of fever, what is the likely
cause of fever?
A. Atelectasis
B. UTI
C. DVT
D. Drug fever
E. Wound infection

73. 25 years old boy comes 5 days after appendectomy with fever, what is the cause of fever?
A. Atelectasis
B. UTI
C. DVT
D. Drug fever
E. Wound infection

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74. 70 years old at HDU, he suffered from low grade persistent pyrexia 10 days after colectomy.
What is the cause of this fever?
A. atelectasis
B. UTI
C. DVT
D. Pneumonia
E. Wound infection

75. 55 years female suffered from 1cm BCC on the nose, removed up to mucosa level, ala, cartilage
also, what is your management?
A. Split thickness graft
B. Full thickness graft
C. Pedicled local flap
D. Free flap
E. None of the above

76. A patient with laceration scalp 1 cm and no periosteum removed. What is the management?
A. Primary closure
B. Delayed primary closure
C. Split thickness graft
D. Full thickness graft
E. Rotation flap

77. A 24 years old man presented with a 1cm soft and cystic swelling in the inner aspect of the
lower lip mucosa. It is not painful with clear content. What is the likely cause?
A. Abscess
B. Dermoid cyst
C. Pyocele
D. Chylocele
E. Mucocele

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Notes

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