September 2017, MRCS part A

EMQ Rib # management

1- young athlete with single rib #, CXR free after 3
hrs
Analgesia and discharge
2- old age with COPD with single rib # , CXR free after
half an hour
Admit and analgesia
3- middle age with multiple rib # in severe pain, CXR
pneumothorax
Rx-chest drain

EMQ Femoral #
4- 1-80 years SELF DEPENDANT female with # neck of
femur ?
Hemiarthoplasty (there wasn’t THR in options )
5- 2- known case of ca breast with subtrochantric #
Internal fixation
6- 3-40years old with displaced subcapital #
Internal fixation

EMQ about pulse oximetry/spo2/level of co2

7- 1-shows saturation of hemoglobin
Pulse oximetry
8- 2-affected by low perfusion
Pulse oximetry
 9- 12 y old boy with osteoid forming tumor in lower
femur? osteosarcoma??ewing??osteoblastoma??
benign bone cyst
10- RTA pt intubated and mechanical ventilation
while examination and turning patient on his back
he had sudden dyspnea??
tube displacement??neurogenic shock??
pneumothorax??sudden increase in ICP

11- Young age return from Bangladesh With

bloody diarrhea and lower abdominal pain
Mucosa severely distorted on sigmoidoscopy??
Entameba, UC, Camphylobacter

12- Man ate barbecued chicken then had bloody

diarrhea?? Campylobacter, C difiicile

13- Inf epigastric vein drains into- external iliac

vein

14- Black toe with aortic aneurysm? Embolus

15- Black toe with DM and positive pedal pulse?
Small vessels disease
16- Patient Post sigmoid colectomy then
discovered he has antithrombin 3 def ??give
warfarin for 3 months??give warfarin for life??
give heparin ??
 17- Acute intestinal ischemia by emboli

EMQ vitamins
18- -Alcohol patient with peripheral neuropathy
B1
19- Post gastrectomy anemia
B12
20- Dry eye and skin
A
21- Easy bruising and delayed wound healing
C

22- Stat q of paired t test

23- Stat q of man whitney test
24- Some audit q cant remember

Pregnant woman with DVT and family history of

similar attack ?? anticardiolipin ab

25- A patient with RTA and multiple injuries.

Developed dyspnea .. X ray show edema
bilaterally….Defect in ARDS…DIFFUSION DEFECT

26- What is the JVP in AF--- absent "a" wave AF

27- Signs and symptoms of Hyperthyroidism with
eye sign? Graves

28- Long history given about hypothyroidism with

TSH low/T3 low? 2ry hypothyroidism

29- Patient with Acromegaly how to investigate

PET scan, AP skull , Lateral skull, Cephalometry
CT (there wasn’t mri in options)

30- Clear q about CPP calculation

BP 110/70 and ICP 18 was given
75
31- Transpyloric plane at what level- L1

32- Origin of inf parathyroid?? 3rd pharyngeal

pouch or 3rd pharyngeal cleft or 3rd pharyngeal
arch

32- Question about planter flexion of ankle…

asking root value L1

33- History of trauma to wrist…lunate dislocation

Asking nerve damage. Median n lesion ?

34- Q about young boy with trauma wrist.

 Xray normal and discharged. Came back after
one week with severe pain at anatomical snuff
box….Scaphoid fracture clear q

35- Q of defect in distribution of both ulnar and

median nerve ??
lower trunk brac plexus(C8,T1)
median trunk of plexus
or median cord
36- What is true about Right coronary artery
1- orign after the aortic valve
2- run in interventicular groove
3- give rise to anterior descending
4-arise from ant ascending aorta

37- Where does great cardiac v run? Ant

interventricular septum

38- Patient for elective hernia repair under

general anaesthesia, Temperatures 35.8 how to
proceed?
Change the room temperature forcefully and proceed UGA
Give IV fluid worm UGA
Proceed without changes
Switch to local?? (my answer)
post pone until at least 36??
39- SA node supplied by vagus

40- Lacrimal gland….Pterygopalatine ganglion

41- Patient with injury to finger while gardening..

Came with swelling of pulp space??
I choose Streptococcus pyogenes
Other options: Klebsiella, staph aureus

42- thorn prick something injury??strept pyogenes

43- Prosthetic valve bacteria ? S. epidermidis

44- Anasthesia in hemodynamics unstable patient

Ketamine

45- Patient with RTA, Developed bradycardia and

hypertension why?
Intracerebral hge

46- RTA with breast trauma and swelling lesion

Fat necrosis

Knee injury
47- 1-twisted knee while playing
Next day with swelling and positive tap
 Unable to fully extend?
Medial meniscus
48- 2- Trauma to knee from side.. with valgus
injury ….mcl clear q

49- Recurrent chest infection with meconum ilius

in infancy? Which test will be abnormal..Sweet
chloride
50- Gene in familial polyposis coli ? APC

51- Breast micro calcification in xray/mamo no

mass do what? Mri ?fnac

52- Hypotension in RTA patient ?

Give fluid and cross match?? ct??

53- Best prognosis in Melanoma?? Breslow

thickness
54- Best prognosis in BCC??
completeness of excision

55- Post splenectomy defect seen in blood??

Increase platelets

56- Post phlebitic syndrome treatment?

I choose compression bandage
 57- Neonate with rectovaginal fistula defect in ?
Cloaca
58- Unilateral cleft lip defect?
Defect in fusion of maxillary with lat nasal
process
maxillary with median nasal process
mandibular defect

59- There is another Qs about RTA and lucid

interval
Extradural hge

60- Why dilated pupil in extra dural left side ?

Injury to left parasympathetic oculomotor

Patient can't smile symmetrical after trauma to facial nerve

during surgery?
Buccal or marginal mandibular br of facial nerve(acc. To
medscape it’s the second one)

61- Patient can not look downward and inward?

Trochlear Nerve

62- Patient with papillary carcinoma with no

evidence of LN on ULS ?
total thyroidectomy alone
total thyroidectomy with lymph node excision
 One more Q about thyroid nodule, palpable
thyroid mass on swallowing FNAC negative Further
plan of action

63- Q Post renal transplant 18 months with

generalised LAP?
EBV
Another one
64- Generalized LAP for 2 years I think?
Lymphoma or reactive lymphadenopathy

65- Q Woman with renal ca and bone metastasis

pain?? Radio(did it) NSAID Paracetamol

66- Rectal bleeding in child?

Juvenile polyp

67- 7 yr old boy …pain in knee and hip limping

Q about perthe's disease
68- 11 yr old obese boy with hip pain
SUFE

69- A nurse developed contact allergy to gloves

type 4 or 1 hypersensitivity ??

70- child with his father working in garden

develop rhinorrhea and iching
 IGE

EMQ oral lesions

71- One with precancerous red velvety lesion in
the mucosa under the tongue lesion ?
Erythroplakia

72- One with blue transparent lesion under

tongue ?
Runula

73- Patchy lesion and Bleeding from tongue

Smoker and alcoholic? Scc

74- Patient with history of pancreatitis Presented

with yellow stool difficult to flush bulky What
deficiency ?
I chose lipase

75- Patient with ca rectum

From which artery blood supply derived from?
I chose IMA

76- Perforated gastric ulcer at the anterior wall of

greater curvature?
Left gastroepiploic artery or Rt gastroepiploic
Splenic artery, Gastroduodenal
77- Patient received warfarin and developed
bleeding Deficiency of ??
1972 factors or vit k

78- Q on scrotal swelling after long standing and

has small testes
Disappeared on supine position?
Varicocele

79- Q First metabolic response of adrenaline?

Glycolysis (not tachycardia like fawzia)

80- Q patient fasting blood glucose > 7 mmol and

post prandial > 11? Dx?
Diabetes mellitus

81- Patient developed recurrent attack of

dizziness and fainting attack? Hypogycemia.
What is elevated in blood
Insulin level
C- peptide leve
Increase insulin + Increase C peptide

82- Which cell depends on Coricycle for its

metabolism?
 Hepatocyte

83- Q Beta1 found in?

Ventricle

84- Q Patient return from Bangladesh develop

painless jaundice?
Hepatitis A

85- Patient with UC presented with abdominal

pain… max in LIF and High grade fever
X ray shows Distended transverse colon?
Toxic megacolon

86- Localised Annular ca sigmoid colon, no

secondaries Type of surgery?
left colectomy and anastomosis
Hartman (did it and mostly wrong)

87- Q Patient with difficult swallowing after long

time of reflex
Cancer oesophagus

88- Acidosis in diarrhea, due to defect in

Lose of HCO3
 89- Patient smoker with continuous cough Wash
out shows Squamous cell what changes
happened?
Irreversible or reversible changes??

90- Q What goes with absolute acidosis ?

something
Cant remember options but mostly was urinary ph
by exclusion

91- Patient with multiple # Develop sign of PE

Diagnosis?
CT angio

92- Cardiac output at rest in athletic heart?

5 to 6 lit per min or 8 to 10 lit per min

93- Temporal tenderness high ESR?

Giant Cell Arteritis

94- Non caseating necrosis found in

Tb
Sarcoidosis
Crohn disease
Celiac

95- Scenario of DIC

 96- 2 q about shock types can't remember
97-
98- ECG in Repolarization of ventricle-T wave

99- External urethra sphincter Supply by what root

S2,3,4

100- Incontinence after delivery

Normal sphincter anatomy
Pudendal nerve

101- A male patient was examined PR.

Posterolateral structure in PR exam 4 cm from
anal verge ?
Puborectalis, seminal vesicles, prostate

102- A doctor examine female patient…PV

examination --ant structure palpable is
base of urinary bladder, fundus of uterus,

103- Site of ectopic testes ? root of penis

EMQ Incisions and structure divided

104- One pfennestine? Rectus sheath
105- Upper midline ? linea alba
106- Inguinal surgery ? ext oblique aponeurosis
 107- Lumbar puncture surface marking…Level of
ilac crest ? L4

108- Q of male vs female anatomy of pelvic bones

Difference in male and female pelvis
109- Renal artery posterior to renal vein

110- 2nd cervical vertebra feature ?? bifid spinous

process ( No odontoid in options )

111- Q about hydrocephalus and Dilated lateral and

third ventricle? Obstruction of Silvius aqueduct

112- Q about structures at popliteal fossa..Closest

to knee joint ? popliteal artery

113- Q tumour marker of melanoma ?

I choose none of above
114- Q marker of breast cancer??
CA125?? CEA?? NON OFABOVE??

2q similar
115- 15 patient with loss of lumbar lordosis and leg
numbness
116- 20s weight lifter with loss of groin sensation
and leg numbness
 Central prolapse
Post lat prolapse
Spondylolisthesis

Stupid EMQ resuscitate

117- One Post appendicectomy and low urine out

put
118- One with RTA severe hypotension
119- One Severe asthmatic and in distress

Answers
500 ml hartman solution and observe in half hour
2 litre hartman rapidly
CPP ventilation

120- Old age with history of cervical OA

Presented with numbness in upper limb how to investigate?
MRI

121- Complex supracondylar Investigation # ? ct

122- Q Pregnant lady with suspected perforated

DU? Asking for investigation? CT, USG
Chest x ray
123- Patient post cholecystectomy 3 day with
abdominal pain tachycardia investigation?
CT, USG, Coeliac angio

124- Same scenario With PR 100

BP 90/60 Cool peripheries Afebrile
Cause?
Intra abdominal bleed

125- Q chronic COPD ABG shows ? High co2 high

hco3

126- Patient post op. Diabetic and on insulin. No

oral intake. On IV fluids NS and Hartmann
developed confusion and convulsions. Reason?
Hyponatremia, Hypoglycemia

127- Q of peri op management of diabetic pt? did

glucose monitoring can't remember others

128- Q rapidly increases thyroid mass with fixation

to other tissue?
Anaplastic

129- Medial border of femoral hernia

130- Q relationship of brachial artery and median
nerve at cubital fossa

131- Multiple myeloma on Xray finding

132- Q Patient with general fatigue and weight loss

With positive Benz jones protein in urine and passing
pink color particles
Amyloidosis

133- Obstuctive jaundice with pale stool and yellow

urine what is Increased urine ?
conjugated bilirubin
Urobilinogen

Q initiation of abduction of shoulder?

Supraspinatous

134- Q renin act on what? Angiotensinogen

135- Q cerebropontine angle tumour involve which

cranial nerves? CN 7 8

136- Q patient presented with hyper pigmentation

? addisson crisis

137- Nerve supply to angle of mandible? Great

auricular or auriculotemporal
138- Fluid maintenance postop ?
2 litr NS and 1.5 GW 5%

139- There is Q about patient with history of

carcinoid Diagnosis?
Ct or barium or urine VMA
140- Increase ADH lead to?
Increase fluid in ECF or ICF or trasnscelluar

141- One young age male with neck pain and uvula
shifted to another side? quinsy

142- Child with high grade fever and neck spasm to

one side with noisy breathing?
Retropharyngeal abscess or Ludwig angina

143- 39 years female with family history of ca

breast, asymptomatic. Screening by?
Mammo or us??

144- Q Multiple small gall stone.. due to Increased

what?
Unconj bil
 145- Q Patient with Pancolitis Least likely to
happen? Which extra intestinal manifestation is
least likely to occur in patient with UC?
Polyarteritis nodosa

146- Q Patient can not do opposition of thumb

Recurrent br of median nerve (specific for opponens)
Deep branch of Ulnar

147- there is a case RTA with shock Sign of acidosis?

In the choices decrease bicarbonate

148- The process which Enhance bacterial

ingestion?
Opsonization

149- Q Multiple LN What to find on biopsy?

Multiple abnormal mitotic figures

150- History of appendicectomy

With yellow granules from RIF wound.. easy
Actinomycosis

151- Case post op received large amount of blood

transfusion developed SOB?
Fluid overload or hemolytic
152- Q post TURP Hypotension and confusion..
electrolyte abnormality

153- Most common sign of hyponatremia?

Confusion

154- late complications of blood transfusion

jaundice

155- Bleeding while passing chest tube

Source of Bleeding from? intercostal Artery
156- Hx of pelvic surgery With Post op erectile
desfunction? Pelvic splanchnic n
157- PE what ECG finding direct

158- Patient with long standing celiac disease

What type of lymphoma developed?
B cell or T cell ( t acc to medscape)
159- Which one of the following increase gastric
acid secretion?
Histamine

160- Prosthetic metallic valve behind the sternum

at the level 3rd ICS?
Aortic, Mitral or pulm
161- During tracheostomy Structure in front 2nd,
3rd and 4th tracheal cartilage
Thyroid isthmus

162- Q Epithelial lining of the urinary bladder?

Transitional cell

163- Patient post op sigmodectomy and stoma

formation Which of the following is part of
recovery enhance program?
I did that 1ry care option cant remeb

164- Weird q of frozen section? did Slide before

staining

165- Hyponatremia post op asking the cause?

Administration of Na free fluid

166- Q lose of sensation in dorsum of foot and

dorsflexion? Common peroneal

167- Q Recurrent UTI and pneumoturia?

Diverticulosis

168- Q Hypoxia and hypo ventilation?

insensitivity of central chemoreceptors to PCO2
169- One of the border of anatomical snuff box
EPL

170- Q Which of the following increase water and

bicarbonate secretion from pancreases?
Secretin

171- Lose of foot eversion The sensory area

affected is?

172- Q Why to choice inulin to measure GFR

173- Q Which one used to measure GFR?

Inulin or creatinine

174- Protein C deficiency Defect in what ?

Factor 5 or 8

175- Noradrenaline act on which receptor ? alpha1

176- Scenario of parotid swelling and facial nerve

involvement? Adenoid cystic Ca

177- Numbness of cheek and upper frontal teeth

after trauma to face ?
Infraorbital N
 178- Which of the following is correct regarding
meneitriere disease? I choase gastric ca

DVT prophylaxis 2 q emq cant remeb

179- Patient undergoing sigmoid colectomy??
180- Patient Dm undergoing above knee
amputation??

Patient with duck B classification 5 y survival ? 70%

181- Patient with fall from height or burn With

highly urea and creatinine
With dark urine contain myoglobin?
Rhabdomyolysis

Emq from hell of lymphaadenopathy

Options
Anal cancer
Melanoma
Cervical cancer
Papillary thyroid cancer

Qs
182- Patient return from Australia to UK has
unilateral inguinal LN
183- Patient has underwear bleeding and bilateral
inguinal LN
 184- Patient has no neck mass and post triangle LN

EMQ 2 Q
185- Patient with # neck femur before one year
Treated by internal fixation Now presented with pain and
stiffness of hip?AVN

186- Patient with metatarsal dislocation # , wire

fixation After ten years with pain and stiffness ?
post traumatic OA

187- Patient with left side leg weakness What

circulation? Right anterior cerebral artery

188- Defect in pleuroperitoneal membrane result in

? bochadelek hernia

189- From sheet fawzia, Absent femoral pulse and

radial pulse intact
Inturrupted aortic arch syndrome

190- Hypothermia first response ? Vasocontriction

Or something about hypothalamic responce

191- Blood supply to cecal tumor? ILEOCECAL

192- Procesus vaginalis derived from? Peritoneum

 193- Patient with miosis and hyperhydrosis with
blinking defect? I chose stellate ganglia

Emq 2 q

194- Patient planning for elective inguinal surgery

Hb 9 How to correct?
I chose give haeme oral iron preparation

195- Cant remember other one

196- Patient with renal failure Serum k 7 What is

the first action ? Calcium gluconate

197- About anatomy of spleen

Which of the following is true? I chose contain macrophage

198- Patient works in vinyl chloride factory Develop

liver mass ? Angiosarcoma

199- Patient with HIV and thyroid mass what are

the action?
Repeated investigations
Post pone surgery
Inform all the staff in the theater
Continue with prophylaxis(did it)
 200- Patient with anal ca Associated with? HPV

201- Patient on oral antibiotics developed

dysphagia? Candida

202- patient with multiple radio opaque stone

Analysis confirm ca oxalate stone What is the
cause?
I chose hyperparathyroidism
Familial hyperoxaluria (right answer)

203- Q Patient on warfarin with INR 5

He is about to undergo surgery for strangulated femoral
hernia
IV vitamin K (my answer)
FFP
Aspirin
prothrombin complex

204- Patient post gastrectomy developed B12

deficiency Blood picture will show??
Megaloblasts

205- Correct about right ventricle ?

Forms the apex of heart
contact with diaphragm
206- Q Most of pain stimulus transmitted by?
Spinothalamic tract

207- Temp tract ? spinothalamic too

208- Q Pt with trauma presented with Marked

clawing of hand injury to?
Ulnar nerve injury at wrist
Ulnar nerve at elbow

209- Sensation at first web space by ?? Deep

personal nerve

210- Surgery to short saphenous vein, post op loss

of sensation over lateral foot ? sural n
211- Abduction of hip impaired Injury to?
Sup gluteal nerve
212- Q Patient with torticollis
Injury to spinal accessory nerve

213- Patient with numbness of hand and tingling

sensation with dripping objects
Awake him at night
Diagnosis as CTS? Treatment Decompression
 214- Posterior leg compartment syndrome
diagnosis by Hallux flexion, Hallux extension ( my
answer) Ankle planter flex

215- Q Injury to ring finger distal phalanx>fdp

216- Patient with ca breast treated by wide local

and radiotherapy Now presented with back pain
How to investigate ? Ct, Xray MRI(answer) PET

Emq Management of head trauma

217- Patient with GCS 11 and depressed skull #
218- Patient old age with fall and repeated vomiting
219- Patient alcoholic and fall
Not knowing if lose Q or vomiting
There's small wound on eye brow
My answers Neurosurg refer
Immediate ct, observe 3rd

220- Patient with thyroid nodules

FNA shows benign cell? Hemithyroidectomy

221- Q Erythematous tender swelling of the breast

How to differentiate it from inflammatory
carcinomatous?
No response to Ab(my answer)
nipple inversion
 Associated with mass
222- Q 55 year old with ca pancreas Obstructed
jaundice With single liver metastasis ? Treament
ERCP stent

223- Q Patient with thyroid nodule and pulsatile

forehead mass? Follicular Ca

224- Q testicular torsion How to treat ? Fixation

orchidopexy

225- Q 25 yr old male ..appendicectomy done 1 yr

ago for carcinoid of tip of appendix.
Presented with facial flush and diarrhea?
Investigation? Ct, small bowel enema,
large bowel enema

Q After passing central line Patient collapses?

Tension pneumo

226- Herpes zoster on T8 T10 site?? Costal margin

227- Disease resulted from failure of neural crest

cells to migrate? HSP
228- Alcoholic drunk patient with urgent desire to
pass urine, Run and fall with trauma from wall His
urgency disappeared. Next day presented to ER
with lower abdominal pain and complaining of no
urine out put Bladder empty by exam
Just tender lower abdomen? UB RUPTURE

229- Q Reason to give steroid to brain tumor before

surgery? Dec peri tumour edema (my anaswer)
Dec tumour vuscularity
Dec tumour size

230- Q Osteomyelitis in SCD? Salmonella

231- Patient post op for anal fistula

Not healing With RIF pain ? CD

232- Botulinum toxin act by? BLOCK ACH

233- There's is Q About Old age with

claustrophobia patient and metallic valve With
trauma and fall on shoulder
How to investigate? Ct, Mri, Xray (MY ANSWER)
PET sca, USG

234- There was that q of finger swelling History of

trauma not tender not attached to skin no foreign
 body inside? Abscess, Fb granuloma, Aneurysm
digital a, Epidermoid(did it by exclusion)
235- A man came with left loin pain, USG shows left
hydronephrosis and a bladder mass.. Dx?
TCC

237- A patient with painful shoulder. Painful arc

with pain between 60 to 120 degree shoulder
movement. Tendon involved?
Supraspinatous
238- A question on Baroreceptors… which
mechanism acts first in the body in case of
hypovolemia and hypotension.

239- A patient with problem of finger extension

and mild wrist extension difficulty.. no sensory
loss… nerve injury? PIN
240- In cushing disease due to pituitary tumor
abnormality seen in adrenal gland is….
I choose adrenal hyperplasia
241- A patient developed hypotension
immediately after passing foleys catheter….. latex
allergy ( Fawzia sheet )
242- A patient with pharyngeal diverticulum.
Asking the insertion site of diverticulum..
Through inferior constrictor muscles ( I chose it)
Between medial and lateral constrictor
Above the inferior constrictor

243- A 8 yr child with swlling in neck. Biopsy

shows pleomorphic malignant cells with osteoid
formation…Dx?
Gaint cell tumor, enchondroma, lymphoma

244- A patient with tingling and numbness in the

thumb and index finger… more at night. Positive
Tinel's sign. What is the most appropriate
management?
Analgesia and rest
Division of flexor sheaths
Brachial plexus exploration

245- Prolonged QT with pancreatitis

Asking the electrolyte abnormality?
Hypocalcemia
Hypercalcemia
Hypokalaemia
Hypo or hypernatremia

246-A patient received blood transfusion. 30 min

later he developed hypotension, tachypnea and
back pain.?
Acute haemolytic reaction
Non haemolytic reaction
247- which one of the following blood transfusion
reactions occur late?
Fever, malaise, jaundice, haemotylic reaction

248- 50 yr old diabetic male, admitted for THR.

After surgery, he had anuria. Vitals signs normal.
No signs of dehydration.
Underactive bladder
Renal stone
Bladder rupture

249- 35 yr old male patient. Admitted 4 days ago

for perianal abscess drainage. Discharged. He
presented to ER with diffuse painful gluteal skin
irritation redness and fever?
Erysipela
Cellulitis
Necrotizing fascitis

250- A 45 yr old female patient admitted 4 days

ago for elective LAP chole and discharged without
any problems. Patient came to ER with severe
abdominal pain. Vitals: HR 96, BP 100/90. Temp:
36. RR 25, WBC 3.5 and Hb 10.
Dx?
Biliary trauma
Post biliary syndrome
Gram negative sepsis
Post op bleeding

251- similar question, same scenario

Asking for investigation?
CT, USG, coeliac artery angiogram,

252- EMQ ear discharge

A patient with 40db hearing loss and painless
discharge- cholestetoma

A child with ear discharge, pain relieved after ear

discharge- ASOM

253- long scenario patient with post op diarrhoea

due to antibiotic use. Dx as cl diffiile diarrhoea.
Asking for treatment?
Oral metro
IV metro
Oral vanco

254- a young patient presented with slow urine

stream and increased frequency of urine. Had
fever , urethral discharge and dysuria 6 months
before…..
Urethral stricture
 UTI

Recalled and
edited by
Dr iea rabee
Dr ahmed
ashour