qsMaster The MRCS Part A Study Group Family

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May 2022 Team Recalls
Together we Can Together we did it Together we will Continue, with the Grace of God

1. Ecg - S1Q3T3 pattern ans PE

2. CVP normal. SoB. CXR shown = ARDs

3. Hammer injury nail/finger, wound that bleed on touch - Pyogenic granuloma

4. H/o stoma correction 3 months back, swelling at that site, now come with sudden
abdominal pain, vomiting - incisional hernia

5. Choice of inv for ischaemic foot in ckd pt - duplex/angiography/doppler

6. Total knee replacement, likely structure to injury during tibial sawing

- Popliteal artery
- CPN
- Tibial nerve
- Medial collateral ligament

7. 7. Mid tarsal #, managed, came after 10yrs, with new onset of pain - Primary OA/2nd
OA/AVN…

8. Stereotactic frame skull, bleeding posteriorly - occipital art (Fawzia)

9. Emergency tracheostomy - landmark? (halfway between cricoid and sternal notch)

10. Smoker 1 peripheral lung lesion with 2 other ground glass opacity - Squamous cell Ca /
adenocarcinoma/ small cell ca

11. 1 scenario of Perthes (recall) (Clearly mentioned child is fit)

12. scenario of SUFE (recall) (Clearly mentioned child obese…)

13. 1 qs regarding post dislocation hip movement lost - knee flexion lost: sciatic nerve injury

14. scenario of pregnant pt ,3rd trimester(fhx father recent MI at 65), tightness of chest,neck
veins were distended - may b massive pul embolism

15. Plan Elective inguinal herniotomy under LA, temp 35 - 250 ml warm iv fluid/start ot with
forced intraoperative air warming/intaperitoneal warm fluid/ op under GA
16. Female painless swelling visible on standing immediately goes away on lying, positive
cough impulse, no thrill - I choose Saphena varix, many say F. Hernia

17. Qs about burn fluid calculation (2 forearm + Ant surface of BL thigh ; 70/80kg)

18. Qs about CPP measurement (BP 125/75, ICP 30, JVP 10)

19. Glans penis ulcer/carcinoma, LN where? - Deep ing LN

20. Pt e MM in situ, complete excion e 2 mm/1cm (cant remember) margin clearance, what
to do next? - I choose discharge e self education

21. 20 y female e 3 cm breast lump, FNAC benign, what inv to do - US 3 month review/core
biopsy/excision bio/discharge

22. Soldier marching,callus found in x ray (Fawzia Q) - stress #

23. Athlete, knee twisting injury, immediate swelling, came after few months, ant drawer test
positive > Ant cruciate lig injury (Fawzia)

24. type of amyloidosis in cardiac biopsy- AL amyloid, AA amyloid, beta microglobulin. Ans
is AL amyloid

25. elective surgery with hypothermia what to do and the wasn't choice to postpone and last
choice was critical incident report / inf 250 ml warm saline

26. ureter blood supply all except ( renal , gonadal , uterine , ileolumbar superior vesical )

27. Embryology of bladder - urogenital sinus

28. parathesia & tingling sensation of palmar and dorsal surfaces of little and ring finger all
choices are ulnar but which branch ( dorsal branch of UN/ superficial branch of UN/UN
injury palmar / injury at wrist , injury at upper forearm )

29. painful ulcer above lateral mallelolus absent pedal pulse diabetic h… what risk factor (
atherosclerosis , diabetic , vasculitis , venous, HTN)

30. 80 years alcoholic 7 units per week , history of few times previous confusion & patient is
taking thiazides diuretics for HTN , preop Na 130 … post op confused which one more
risk for confusion ( age , previous confusion , sodium , alcohol, HTN)

31. stone lower ureter 8mm , rigors , fever …. Cystoscopy and JJ

fixation/ESWL/Nephrectomy/antibiotics
32. Enhanced recovery protocol most benefit ( decrease hospital stay at 30 days , decrease
risk of minor complications at 30 days , decrease risk of major complications at 30 days ,
decrease readmissions at 30 days )

33. hematuria CT show heterogeneous mass kidney ( TCC ,RCC)

34. ROOT value for lateral cutaneous nerve of the thigh and passes lat / on/ medial pf
psoas muscle

35. origin of tympanic Cavity ( 1st pharyngeal pouch, 2nd pharyngeal cleft, tonsillar cleft)

36. asymmetrical smile which branch of facial nerve affected ( zygomatic , marginal
mandibular , buccal , mental nerve…..)

37. 23 years female with breast lump which imaging give you DEFINITIVE diagnosis ( us ,
mamo , MRI )

38. Cancer cervix mets to internal iliac nodes which 2 other groups draining ( ext iliac and
inguinal , ext iliac and sacral , inguinal and aortic , sacral and aortic ….)

39. Burn calculation fluid 2 FRONT thighs, 2 forearms , 80 kgs, adult patient

40. Post op patient NPO paralytic ileus which fluids gives him sufficient sodium ( 2 D5
+NS0.18 , 2D5+1NS0.9 , 3L HARTMAN …..)

41. Lower border of quadrangular space- Teres major

42. Hemolytic uremic syndrome organism- E.coli

43. ERCP is done in patient with benign CBD stricture , after 12 hours of procedure, fever
and abdominal pain( stone , cholangitis , pancreatitis,duodenum rupture …..)

44. Pancreatitis for 5 days CT show non enhancment of part of body and tail and huge
collection behind the pancrease, contrast perfusion was restricted( psuedocyst ,
necrosis,mass, abscess)

45. Trauma to knee, now lower limb pulse less and no sensation. Nature of injury?
- Patellar dislocation
- Supracondylar fracture femur
- fracture tibial candles
- fracture shaft femur

46. Which part of temporal bone contributes to form pterion

 ● Mastoid
● Petrous
● Squamous part

47. Lateral wall of femoral canal

1. Pectineal ligament
2. inguinal ligament
3. Femoral artery
4. Femoral vein

48. What structure is in relation to both first and second parts of duodenum?
- IVC
- Ureter
- Gonadal artery
- Right kidney

49. Fluid collection in knee joint & pain . No trauma, no fever . Wbc value is normal. What is
the diagnostic investigation?
- Arthroscopic
- Aspiration and microscopic examination
- MRI

50. No wrist movements and loss of sensation lateral part of forearm. Site of injury?
- AIN
- PIN
- Radial nerve
- Ulnar nerve
- Musculocutaneous nerve

51. Calculation of glomerular filtration pressure. Hydrostatic & oncotic pressure for
bowman’s capsule etc. given.

52. Ureter receives blood supply from all but?

- Ovarian artery
- Iliolumbar artery
- Uterine artery
- Superior vesicle artery
- Superior mesenteric artery

53. Ischioanal abscess relations:

- Medial to pudendal canal
- Within deep perineal space
- Within superficial perineal space
- Above levator ani
54. Relation of right renal artery- ant of ivc, post of renal.vein/post to IVC

55. Development of vsd - bulbur cordis/ septum primum/ septum secendum

56. Choice of treatment 10×3 cm , over shin , exposing bone - flap, primary stsg, delayed stsg

57. Choice of treatment- flap injury over tibia- excise flap and stsg , only stsg,

58. Organism of discitis - stap aureus / m.kansasi/ s.pyogens

59. Loss of strong grip after injury in the axilla like cant hold suitcase handle .- post cord /
median/ ulnar/ radial

60. Reciprocal of absolute risk reduction - number need to treat / relative risk

61- family doctor.doesnt follow instruction of hospital doctor in giving medicine - medical audit /
inform medical council /incident report/review prescription

62- structure lies medial to phrenic while entering thorax from neck on rt side - trachea/ br trunk /
subclav art/ br vein / right atrium

63- structure on sc ant muscle - phrenic n ? - Long thoracic nerve

64- structure injury in level 5 neck dissection on post triangle supraclavicular area will produce -
arm weakness / winging / tongue deviation / (CN11 injury)

65- anterior feature of heart - formed by mainly left ventricle/ ant coronary art is visible / right
branches of coronary artery visible

66- Femoral artery site - between ASIS and public tubercle/ between ASIS and public
symphysis

67- flaccid muscles lower limbs, areflexia- site of lesion? upper motor/ lower motor/

68- TSH <001, T4 Normal. T3 10.8 ( slightly raised), diagnosis? - hyperthyroidism/

hypoparathyroidism/ T3 toxicosis/

69- Humeral shaft fracture with thyroid Ca - ? Follicular/ Medullary/ papillary/ undifferentiated

70- external spermatic fascia is derived from- external Oblique aponeurosis

71- Depolarising agent- Suxamethonium

72- midline swelling moves with tongue. Diagnosed thyroglossal cyst, why do you need to
operate? - recurrent inflammation/ may contain thyroid tissue / risk of carcinoma

73- Potential space? Sinus tarsi is formed - sinus between- calcaneus and cuboid/ talus and
calcaneus/ calcaneus and navicular

74- 10 month old child passing blood, crying- intussuception/ Meckel's/ Juvenile polyp/ anal
fissure

75- Senior doctor have his opinion regarding managing a patient. Level of evidence? - l/ll/lll/lV/V

76- ASA uncomplicated lipoma removal- l/ll/lll/lV/V

77- Patient complains discomfort to loud noises after accident. Injury to which nerve? -
7th/8th/5th

78- Osteoid forming malignant bone tumour

79- GFR calculation.

80-Neurogenic Shock ( pt had crush injury at the level of c5/6,)findings

81- GCS score- opens eyes to pain, localised to pain and can speak words but
incomprehensible(GCS was 9)

82- which ionotrope stimulates mainly alpha receptor with some agonism of beta receptor ,also
used in rx of septic shock ? Noradrenaline

83- image of an x-ray of a child in icu f/b trauma - ARDS

84 - mediastinal mass in a pt of myasthenia gravis . What is the lesion ? - Thymoma

85- a female post thyroidectomy f/b ca thyroid . Pt receiving T3 supplementation is thought to

have a recurrence of the carcinoma . What will be the appropriate thyroid function test levels?

86 - thyroid biopsy shows CD 20 cells - lymphoma /hashimoto thyroiditis/papillary ca/follicular ca

87- Modern arthroscopy sterilization method- Glutaraldehyde/ Ethylene oxide/ Autoclave

88- Cause of sweating after parotid surgery while eating- reinnervation by auriculotemporal
nerve

89- Sudden onset pain in heel while playing, unable to walk- Achilles rupture (Simmonds test)
90- swollen knee, no history of trauma definite way to diagnose- Joint fluid aspiration/ xray/
Arthroscopy

91- hot water burn in a young child,entire forearm or upper limb, patient have vesicles:
occlusive dressing, leave it open

92- Investigation in a 7 year old undergoing tonsillectomy- none

93.Past h/o of dysuria and urethral discharge 1 year back. Now presenting increased frequency
and poor urinary flow: urethral stricture

94- Breast Ca with nausea vomiting and morning headache: Dexamethasone

95- Vasodilator in anaphylaxis: Histamine

96- Diagnosis of anaphylaxsis: Tryptase/histamine/IgE level

97- Multiple fracture patient has lost more blood,first substance released in response to
hypotension- renin/angiotensinogen/angiotensin 2

98- Aortic aneurysm 4.7 cm - what to do- monitor with USG

99- Which of the following is not a risk factor for AAA- DM

100- Hypercalcemia in malignancy: PTHrp

101- Structure not injured in tracheostomy: Ascending pharyngeal artery

102- Pt with SOB and pulmonary capillary wedge pressure>20 mmHg- Heart failure

103- Pt undergone aortic valve replacement develops HR of 40/min: Chose Left ventricular
failure, other options: Heart block/ Cardiac taponande

104- Child with swollen tonsil, meeting in midline, membrane covering the tonsil bleeds on
attempted removal and has fever- Chose diphtheria, options- Acute tonsillitis/Quinsy, diphtheria

105- postsplenectomy what is not seen- choose Low WBC count, other option basophilia/target
cell/ papenheimer body/heinz body

106- Mediastinal widening where is the site of injury: Choose descending aorta

107- Pelvic fracture with high riding prostate: Membranous urethral rupture
108- immunoblast seen in pt with fever and lymphadenopathy: (choose Non hodgkins
lymphoma,) /hodgkins lymphoma

109- Peripheral ca lung in smoker with 2 ground glass opacity: Adenocarcinoma/ SCC/ Small
cell carcinoma

110- Head injury, wife reports loss of consciousness for 15 sec, GCS-15/15 - Admission and
observe/ Urgent Ct/ discharge with instructions

111- Full thickness burn with forearm- split thickness graft

112- Analgesic effect of opioid: mu and kappa receptor

113- Vasodilator in anaphylaxis: histamine

114-Aneurysm pathogenesis: loss of medial elastin

115- pain in walking, relieved in walking uphill: lumbar canal stenosis

116-component of intrinsic pathway: Factor 9/ Factor 8,12a

117- Action of gastrin on : parietal cell

118- Intraop rejection of transplanted kidney: ABO incompatibility

119- Parietal lobe mass with homonymous hemianopia: optic radiation, optic tract

120- Calf pain without pulse: stenosis at popliteal artery/ superficial femoral artery/ external iliac
artery

121- Scenario suggesting insulinoma: C-peptide and insulin increased

122- Cholesterol level increased in- Hypothyrodism

123- Pic of ranula: arise from sublingual gland

124- Dryness of eyes Following le forte fracture : Pterygopalatine ganglion/ ciliary ganglion/
submandibular gangilion

125- Veteran Nurse with allergic reaction with gloves: Type IV hypersensitivity reaction

126-type of polyp found in FAP - hyperplastic/ tubular adenoma / adenomatous /

127 -smoker elderly male , presented with hematuria , lesion seen in the kidney pelvis (?) - rcc/
rcc
128- obese woman with painful ulcer in the lat malleolus , reduced pulse in the limb - vasculities
/ atherosclerosis
129- osteoid forming tumour in the xray of a child of 10 yrs in the lower part of thigh -
osteosarcoma/ ewings sarcoma
130- after vomiting elderly man presented with hematemesis - mallory weiss/ borheave synd/
peptic ulcer / esophageal perforation
131 - pt is getting lmwh+ aspirin+ clopidrogel post op , now presenting with oozing from the
margin of wound, platelet count normal - platelet dysfunction due to drugs / dic /
132- elderly pt was found in shock with huge blood that he may vomitted previously on floor ,
diagnosed cirrhosis of liver ,pt+ aptt raised ..cause of bleeding - varices / nsaids /
133- pagets disease associated with - dcis / lobular ca/ invasive ca
134- fever , lymphadenopathy , immunoblasts found , dx - inf mono neu./ lymphoma /
135- after # femur , surgery done pt was in shock and received lots of unit of blood , now wound
is oozing.. platelet count low,Aptt,PT,Bt all low,FDP raised - dic/ nsaids /
136- histology of barretts - columnar epithelium with goblet
137- first structure pierced in lumber puncture in the spinal canal - lig flavum/ post log lig/ ant
long lig- dura

138- A lady came with H/O 6 months Lethargy, Inv:

TSH: low
T4: Normal
T3: slightly raised

Ans: T3 toxicosis, primay Hypothyroidism, Secondary Hypothyroidism, Hyperthyroidism? T3

toxicosis (googled it & it matched)

139- Haemolytic Uraemic Syndrome : E. Coli

140- Heart Transplant, after 6 weeks Pneumonia, Causative Organism: CMV

141-COPD patient scenario…which one wil be fit

Co2 & hco3 will rise
142.In the lower part of forearm relation of Ulnar artery with ulnar nerve: UN is Ulnar to ulnar
artery
143.oxyphil cell found: follicular ca
144.A patient has pancreatitis & admitted in in hospital, after doing ECG, it shown prolonged QT
interval,perioral twitching:hypocalcemia

145.A patient presented with obvious ecchymosis on her body also some evidence of abnormal
healing.which vitamin is deficient for this
A.vit A
B.Vit B
C.Vit C
D.Vit K
E.Vit 12
Majority choose vit c,may be ans is vit K

146.Hypovolemic shock with sepsis ABG findings

147.Renal transplant patient scenario : tertiary hyperparathyroidism
148.A picture showing red lesion in upper forerarm also there is a red streaks below
Lymphangitis/pyogenic granuloma
149.pyogenic granuloma scenario,organism: streptococcus pyogens
150. Pancoast tumour resection:lower part of brachial plexus injury or something like inner arm
sensation loss
151.MRSA positive before ot: clorhexidine OD 10 days/ mupirocin ointment BD for 5 days
152.patient has crohns disease,250 cm resected: TPN/ oral feeding/ PICC
153.pt. Has microcytic hypochromic anemia,Hb was 9..will undergo a surgery,anemia
corrected? Oral iron for 3 months
154.picture showing a landmark between the lateral malleolus & posteriorly extending til lateral
aspect of Achilles tendon, cutting this line which will injure?
Sural nerve
155.hand is placed in the table facing palmar surface on ceiling,thumb unable to move upwards:
abductor pollicis brevis
156.left sided hemisection,brown sequared syndrome,findings: left sided weakness,right sided
pain & sensation loss
157.first response in hypothermia: peripheral vasoconstriction
158.hx of rectal bleeding,diarrhoea,histology shows granuloma: cronhs disease
159.long scenario,histology shows necrosis of fawzia: mycobacterium tuberculosis
160.a patient has dry mouth,bilateral parotid swelling,hypercalcemia which resolves after steroid
rx: sarcoidosis
161.proximal enterocutaneous fistula,fluid loss…resuscitate by Hartman solution
162.child undergoing operation: fluid 0.9% normal saline
163.long scenario about gastric outlet obstruction,findings: hypocholremic
hypokalemic,hyponatremic metabolic alkalosis(hco3 was rise)
164.Excessive infusion of saline: hyperchloraemic acidosis
165.left sided varicocele,investigation: abdominal USG
165.premature baby,long scenario : necrotising enterocolitis
166.FEV1 & FVC value were there,calcuation ration was 36%: bronchiectasis,
167.A pt with pancolitis,least likely develop: polyarteritis(fawzia q)
168.Frusemide action site: ascending limb of loop of henle
169.fawzia q 22
170.36 year female,brown discaharge,smoker: plasma cell mastitis/ duct
papilloma,/Fibroadenoma(duct ectasia was not in option)
171.a long scenario with hx of rectal bleeding,diarrhoea,family hx of FAP, colonoscopy shows
there is a polyp but not cross the basement membrane?
Dysplasia/ metaplasia/ neoplasia
172.The fight or flight response produces a release of epinephrine. What is the primary
metabolic effect of epinephrine?
Glycolysis(fawzia q 84)
173.scenario about a ABG: compensated resp acidosis
174.dobutamine work in : beta 1 receptor
175.pontomedullary junction,nerve exits: facial & vestibulocochlear
176.scenario with back pain,ca high,ESR high: multple myeloma
178.old age patient,back pain,x ray shows osteosclerotic lesion: prostate ca mets
179.fawzia q: ans was isovolumetric contraction
180. Pt has head injury,2-3 days later showing hematemesis,upper abdominal pain
: cushing ulcer
181.a scenario of compartment syndrome
182.Adrenal insufficiency scenario: hydrocortisone 150 mg
183.meckels diverticulum blood supply: ileocolic artery/ SMA/ Rt colic artery
184.a postmenopausal lady has NOF fracture,back pain,findings: normocalcemia( dx
osteoporosis)
185.distal radius fracture,anesthesia choose: prilocaine
186.parathyroid gland adenoma inv: sestamibi scan
187.Gastrin works on : parietal cells
188.pudendal nerve root value: s234
189.a pt present with anal incontinence: pudendal nerve
190.A scenario about leriche syndrome: bilateral common iliac stenosis
191.lower lip numbness: mental nerve
192.which is pass below the piriformis: nerve to obturator internus/ obturator nerve/ obturator
muscle tendon
193.Anal ca lymphatic drainage: superficial inguinal LN
194.A pt with hepatic flexure mass,undergone surgery,feeding regime: oral after 24 hours
195.A pt fall on outstrched hand with sensory disturbancr in area soneupplies by median nerve
inv : all xrays of wrist options
X ray wrist dorsal view & Ulnar deviation/ Xray wrist post to ant view/dorsal tilt view/volar tilt
view/pure lateral view
196.support of uterus: central perineal tendon
197.Little finger dermatome: C8
198.content of calots triangle: cystic artery
199.A long scenario with findings of dorsiflexion of foot & great toe extension:L5
200.A scenario of rupture of bladder
201. Dermatome of area over medial epicondyle
202.long scenario. Pt diabetic, hypertensive, underwent some major surgery. After 3 days, pt
develops oliguria with bp and pulse rate increased. Cause?
203.type of Na ,K action:active transport ,facilitated diffusion,......