MRCS Part A 25th jan 2011 : recall concentrate in clinical anatomy and orthopedic time is only ur enemy especially in paper 1 no calculation no long questions paper1: 1-tredelenburg sign , which muscle tested à Gluteus medius and minimus 2-fall on out stretch hand result compartment and parathesia on median nerve distribution, disslocation of lunate. 3-Posterior perforating duodenal ulcer bleeder?gastroduodenal artery 4- loss of sensation on medial aspect of arm , root value T1 5-pt hitten by hard subject in head violent , sagittal sinus 6-muscle of thumb and palm supply by ulnar nerve 7- test pt hand while palm on table he cant touch paper by thumb, lesion of ext polic 8- lymph drainage of cervix, to internal & ext illic 9- pt feel numbness on medial aspect of leg following varicose vein surgery, saphenous nerve 10-knee joint injury about 4 question 11-structures in deltopectoral fossa during dissection 12-nerve found during operating injuinal hernia 13-nerve injured during submandibular gland surgery (Hypoglossal  nerve,  Lingual,  Marginal  mandibular) 14-lateral and third ventricle dilated where site of obstruction (Sylvia) 15-PDA formed from which aortic arch in embryo à 6th arch 16-blood supply of desending colon 17- nerve supply to anal canal 18- branchs of trigiminal nerve & excit foramen for each one 19-lymph drainage of anal squamous cell carcinoma (Sup Inguinal) 20-gall bladder the most distinct part identified during surgery

21-hip joint movment muscle action in ext. rotation 22-dermatoum of lateral aspect of forarm C6 23-medistinal biopsy 24- hemisection of spinal cord , sensartion modilities loss 25-injury during maxillofascial surgrey lead to loss sensation over ant. 2/3 of tongue (lingual nerve) 26-fracture of medial epicondyle which muscle of forarm not affected 27-collection of crainal nerves and its actions 28-neck surgery lead to horseness of voice , unilateral recurrnt 29-pt felt pain in calf muscle , the level of vascular occlusion is? 30- pleural tapping in mid axillary line, 7-9th 31-branch of internal iliac and its supply.Superior gluteal nerve supplies 32- epidural Lumbar puncture, structures pierced, level,Post. longitudinal ligament 33- during TURB using dithermy stimulate which nerve that cause twitching 34-portal vein formed by union of ? bhind , 35- pt loss sensation over web space of big toe, which nerve affected (Deep Fibular?) 36- sternocledomastoid mass in the middle 37- man with groin mass 38- baby with inguinal mass 39-player injury ,Anterior cruciate ligament prevents Ant. dislocation of tibia, 40- coronary circulation 41-surounding testis tunica albuginea 42-fall from horse injury to structure behind Scalenus anterior. 43- Ovale Transmits Mandibular Nerve,Rotundum Transmits Maxillary Nerve 44- sprinting duirng playing football --> pain and post of the thigh. later severe pain

and the lat side of the knee. unable to extend knee dt pain. what is the tendon being involve? --> tendon of biceps femoris 45-a knife penetrate the left of the sternal angle fthe rib with pt normal air entery , tachycardic, 46-IN surgical ICU, with flial chest intubated pt develop breathelessness need increase ventalation pressure ,o2 drop to 70% . what is the most common cause 47- vitamin play role in ,, A , B12 48- extracellular fluid osmolality equal to osmolarity in which part of tubule loop of Henle in pt taken lasix? 49-Angiotensin II, pt with sec HTN taken enlapril 50- TSH, T4, T3 level in gravies , ttt recurennce hyperthyroidism taken thyroxin, in hashimioto in medullary cell carcinoma 51-protein c deficinancy affect factor and cycle of coagulation  

   

MRCS part A 8 Jan 13

some of the questions: 1- Supination of the arm --> C6 2- Claw hand --> T1 lesion 3- what effect of ulnar nerve injury on the thumb movement --> loss of adduction 4- Left line of the heart on CXR what does it belong to (Rt Atrium, Rt ventricle, Lt atrium or ventricle)? 5-Stap injury to Rt side lateral to the sternum what will injure (Hemizygus v., IVC, Rt atrium, Rt ventricle) 6- Lung function in COPD --> reduced RV (I think this is the correct answer) 7- Which mucle affected in the 4th cranial n injury to the eye, patient can't look down specially on coming down the stairs. can't remember 8- patient on warfarin what will it disturb --> 2, 7, 9, 10 9- Most common cause of OM in children --> H Influenza (not sure) 10- Lyning of the bladder àtransitional 11- Most common cause of mesenteric ischemia --> embolism 12- In pancreatitis necrosis happen due to (lipase or amylase or other enzymes)? is it Lipase

13- Chiled spine level for LP à below L2/3 14- Lost sensation side of tongue what nerve à lingual(Trigeminal) 15- numb lower lip after tooth extraction what nerve à inferior alveolar nerve 16- normal anion gap acidosis (don't remember rest of question but couldn't find renal a stenosis or pancreatic fistula among the answers) 17- Child with symptoms of inguinal hernia when at school only ? reason (Gubernaculum, or the other embriological structures for the development in this area) 18- on repairing the inguinal hernia which muscle is disected? 19- Chushings response --> increased BP, increases RR low HR but did not mention the pulse pressure 20-few about tumor markers can't remember 21- fluids for burns? 22- polyps in a rectum of someone with spots around the mouth mostly Peut Jughers what type of polyps --> ? adenomatous 23- Antiphospholipid 24- wound healing 25- acute inflammation --> neutophils 26- COPD --> chronic Resp acidosis 27-fluid over load vs PE cant remember the question 28- the local effect of Lidocaine when injected 29-Chap with head injury GCS 15 initially then 11 with dilated pupil ? site of injury. 30- GCS score, moaning, pointing at pain, opening eyes to pain 31- latix allergy --> type I 32- What other matching is improtant in transplant apart from ABO --> I wrote HLA DR not sure if Rhesus 33- which tendon posterior to lateral maleolus --> Perneous (fibular) longus 34- N. injury lost dorsiflexion and lost sensation over first toe web --> deep fibular nerve injury 35-femoral ring medially--> lacunar ligament 36- lost sensation lateral leg what is the mechanism of injury --> tibial fracture (sural n) others were not related or very high or low 37- A registrar PR a patient 4 cm he felt something laterally what anatomical stucture is it? 38-Hassall cells --> thymus 39- what is anterior to renal artery --> renal v 40- on opening the poplitial fossa what is the first structure --> tibial n. 41- lymphatic drainage of the scrotum--> superficial inguinal LN 42- Lymphatic drainage of the tetsticles --> Lumbar paraortic LN 43- Anterior surface of the hear --> ? Rt atrium

44- Transpyloric plane --> L1 45- where is the commonest site for collection of fluid in the abdo after perf. appendix. 46- lateral posterior approach operation to fix radial head fracture what nerve injured on loosing sensation medial part of hand +/- little and ring fingers movements --> Ulnar n injury 47- Renin product --> Angiotensin I 48- Stomas --> End colostomy, or others including Hartman's 49-Increased ACTH after trauma 50-Anal Ca--> Human papiloma V 51-EBV --> lymphoma 52-factors that increase gastric acidity --> vagal stimulation, Gastrin, Histamin 53-Factor that help Gastrin --> Histamine 54-Dark GB stones on opening the GB --> ? Bile salts 55-Type of cell change in Barret's -> metaplasia Squamousà columnar 56-patient with winging scapula --> Serratus ant. muscle

few questions 1.ear discharge with 40db hearing loss- cholesteatoma 2.ear pain relieved after discharge coming from ear- AOM 3.ear discharge with long standing itching around ear 4.discharge from sinus anterior to tragus in a child -> Otitis externa 5.inv. of choice in a man with thyroid nodule - FNAC 6.treatment of medullary carc. of thyroid - total thyroidectomy 7.treatment in man with pappilary carc. of thyroid of less than 0.5cms with no lymphnodes - hemithyroidectomy 8.treatment of upper ureteric obstruction with .07mm stone and hydronephrosis and fever 9.treatment of 1cm ureteric stone with no hydronephrosis- ESWL 10.bloody discharge from single duct of breast - pappiloma 11.creamy discharge with no cytology - duct ectasia 12.patient on warfarin with few atypical cells on aspiration of breast cyst 13.young female with no mass or cyst but discomfort -?fibroadenos 14. tethewring of breast skin- carcinoma 15.fibroadenoma 16.child with pathological # of femoral shaft with abdo. pain and mass 17.child with skin nodule and brown spots with similar history in sibling - neurofibroma 18.soft swellin at back with rubbing at exam preparations strap - lipome 19.one on infected sebaceous cyst 20.diabetic with loss of sensation on dorsum of foot with pulsation felt in

the same limb -neuropathy 21.pfannensteil incision 22.upper midline abdo. incision 23.rheumatoid lady day1 postop with hypotension and low sodium and high pottasium with long term steroids - adrenal insufficiency 24.hoarse voice after carotid enarterctomy 25.epispadiasis 26.5weeks history of liver failure with raised inr and deranged lfts 27.osteomyelitis in sickle cell anaemia 28.infection from eating watercresses 29.child with pruritis ani 30.lactating mother with big cyst -galactocele 31.presenting feature for left side ca. colon 32.26yr. female with sudden collapse and pain to right shoulder - ruptured ectopic/ovarian cyst torsion

few more questions 1.rupture of FDP 2.child with elbow fracture - median nerve 3.child with haemarthrosis and similar family history- haemophilia 4.head injury with dilated pupils -parasympathetic/sympathetic damage 5.postop long term nutrition in pt. with jejunum of 5cms _ total parenteral nutrition or some fortified diet 6.post op nutrition for oesiphagectomy patient 7.post head injury pt. nutrition 8.penile cancer with multiple small wart like lesions 9.21 year old caucasian with splenomegaly - infectious mononucleosis 10.19 year caucasian girl with gall stones -spherocytosis 11.most common cause of mesentric infarction -embolism/thrombosis/venous thrombosis 12.right gastroepiploic artery is a branch of GDA

1.post op fluid replacement -2litres dext. with 1litre saline 2.problem with basilar artery obstruction - visual problems 3.perianal abscess treatment - incision 4.first treatment for acute fissure -medical treatment 5.non reducible piles- haemmorhoidectomy 6.thromboprophylaxis in pt. with h/o cancer has undergone joint replacement 7.thromboprophylaxis in pt. with PVD has gone AK amputation

8.antibodies to which cells in pernicious anaemia 9.good prognosis in ca. breast -her2 receptor absence/oestrogen +/--- 10.acute rejection in transplantation- t cells 11.endocarditis in lady with very old mitral valve replacement which organismà Strep 12.changes in osteoarthritis- cyst,erosion of cartilage,fibrosis 13.development dysplasia of hip 14.slipped subcapital femoral epiphysis 15.effect of moderate exercise on alveolar Po2 & Pco2 16.effect of pulmonary embolism on alveolar Po2 & Pco2 17.effect of rest on alveolar Po2 & Pco2 18.brown sequard syndrome leads to 19.50 yr. old with new malabsorbtion - ?adult onset coeliac disease 20.patient with vomiting tell his electrolyte changes 21.what you feel posterolaterally on PR examination 22.electrolyte change in patient with diarrhoea and soft mass on PR exam 23.nerve supplying adductors is stimulated during TURP - OBTURATOR NERVE 24.level of conus medullaris in child -L 2/3 25.foreign body lands in which bronchus -right inferior 26.parasternal R side penetrating chest wound will damage what 27.spinal artery damaged in repair of thoracic aorta 28.tibia sagging behind on lateral xray of knee - PCL tear 29.footballer with knee injury with valgus stress test +ve and minimal knee effusion- MCL injury 30.effect of osteoporosis on calcium level in blood 31.immediate treatment of hypercalcemia - iv fluids 32.patient with refractory hypertension - VMA levels increased 33.5yr. survival in dikes B cancer - 70 %

few more to go 1.old man with absent pulses distal to femoral with ulcer over calf- arterial ischaemia 2.old lady with ulcer over medial malleolus and staining of skin around it - DVT 3.artery causing ischaemia of colon beyond splenic flexure - anterior branch of aorta arising at L3 4.decreased urine output 12 hours after surgery- cortisol or vasopressin 5.best to measure GFR - inulin 6.child comes back to # clinic with wrist pain after 1week as he was cleared of any lower end radius fracture- scaphoid fracture

7.testicular pain after vasectomy-sperm granuloma /spermatocele 8.lady with progressing jaundice over 3months and weight loss- ca. pancreas 9.treatment for localised ca. pancreas-pancreatoduodenectomy 10.treatment for grade 4 ca. pancreas- endoscopic stenting or MRI stenting 11.nerve supply of sternocleidomastoid-accesor spinal 12.dysphagia with no relaxation at all of lower esophageal sphincter on manometric studies 13.progressive dysphagia with history of gastroesophageal reflux for 3-4 years 14.neck abscess in adult with tonsil and uvula moved to centre 15.neck abscess in child with drooling and difficulty in moving neck 16.27 yr. old with testicular swelling- carcinoma 17.80yr old with scrotal swelling from groin not transilluminating- inguinal hernia 18.patient died after discharged from ED after road accident with treatment for chest pain - rupture aorta 19.continuation of pericardioperitoneal cavities in child.give diagnosis 20.10 yr. old h/o nidtarsal fracture comes with pain in midfoot- osteoarthritis

Few more questions 1.how to identify C-2 vertebra on X-ray 2.porcine skin graft 3.allograft 4.kidney transplant from identical twin- isograft 5.skin grafting - autograft 6.hodgkins with worse prognosis 7.paraneoplastic syndrome secreting ACTH

A 65 year old man is admitted for a below knee amputation. He is taking digoxin. Clinically the patient has an irregularly irregular pulse. What would you expect to see when you examine the jugular venous pressure? Answer abscent a wave Jugular venous pressure Absent a waves = Atrial fibrillation

Large a waves = Any cause of right ventricular hypertrophy, tricuspid stenosis Cannon waves (extra large a waves) = Complete heart block Prominent v waves = Tricuspid regurgitation Slow y descent = Tricuspid stenosis, right atrial myxoma Steep y descent = Right ventricular failure, constrictive pericarditis, tricuspid regurgitation

A 43 year old man presents with haemoptysis and is diagnosed as having tuberculosis. Which of the cell types listed below will usually internalise the tubercule bacullis? Answer : Macrophages

Questions from paper 2 Part A 8 Jan 13 1- Organism for Hydatid liver disease --> Echinococcus 2- Pruritis ani in a child --> Enterobious Vermicularis 3- Mother and her children with pruritis ani was diagnosed wrongly by GP --> ? salmonilla 4- fibroadenoma 5- creamy nipple discharge 6- Galactocele 7- bone lesion and fracture in a child ? Osteoid sarcoma 8- Primary sclerosing cholangitis in a patient with UC 9- Gilbert Syndrome 10- localised pancreatic Ca with no spread --> ? local excision 11- pancreatic Ca with liver mets--> ? pancreaticodudenectomy and removal of any obvious tumor 12- Calcitonin --> Medullary Ca --> treatment Total thyridectomy 13- well capsulated papillary Ca in one lope --> I answered total thyridectomy but was not sure if the correct answer is Hemi 14- Raised Ca, raised Alk phosphate and low Phosphate --> Pri Hyperparathyroidism 15- low TSH and raised T3 AND T4 --> Pri Hyperthyroidism 16- child with dislocated elbow --> signs of ulnar nerve injury 17- Direct inguinal hernia 18- Spighelian hernia 19- Knee injury --> medical collateral ligament injury 20- Knee injury --> PCL 21- Child with nasal bleed and other symptoms --> naso-something tumor

22- ear infection --> AOM 23- Kidney stone 7mm in the ureter --> ? Uretri=olithiotomy (not sure) 24- kidney stone in the PUJ --> wave distruction 25- sigmoid valvulous 26- bloody diarrohea, with anal fistula --> Crohn's/UC 27- Lt abdo pain, chronic --> what type of stool ? dark blood 28- Child with symptom of intussusseption --> Jelly stool 29- Lady with calcium 3.7 initial managment --> IV fluids I wrote Bisphosphonate which is usually the treament when Ca >3 BUT I think I am wrong it is not the initial treatment, fluids first if not improved give Bis 30- po op hoarsness of voice which nerve (recurrent laryngial nerve not among the answers) ? Vagal 31- Patient for sigmoid colectomy what post op anticoag prophylaxis --> LMWH + stockings? 32- below knee amputation for gangreen got worse after operation and extended --> ? infection 33- after amputation distal leg got swollen ? 34- patient with IHD and peripheral vaascular disease what anticoag prophylaxis--> ? LMWH only ?

 

MRCS Exam 11/09/2012 mcqs

Questions I can recall: pt with high Ca and high pth...primary hyperthyroidism which muscle initiates abduction of shoulder...supraspinatus which structure will be in left 5th intercostal space...right ventricle principle support of uterus... transverse muscles/facia in elbow brachial art relation to median n...lat which process enhances ingestion of bacterias...opsonisation after splenectomy...leucocytosis anatomical snuffbox border...apb one question with nerve injuries...answers were ulnar and another with low trunk brachial plexus inj lymph drainage of scrotum, testes and prostate testicular swelling in children...epidydimal cyst, torsion of morgagni, hydrocele, seminoma, idiopatic scrotal swelling medullary thyroid ca...calcitonin thyroid test interpretationfor thyrotoxicosis, hypothyroidism, medullary ca, pt after thyroidectomy with and without suspection of mts pt with high co2, high bicarbonate, low o2

another question about spinal problems...one was disc prolapse, spina biffida occulta, ankylosing spondilytis few questions regarding s1 dermotome pt with pancreatic tumours...answers were insulinoma, glucagonoma in pheochromacytoma...vanillilmandelic acid in urine skin lesions...seborrhoic keratosis, dermatofibroma, few others cannot recall one with reynauds fenomenon breast lesions...duct ectasy, subareolar abscess, ductal ca, pagets child with walkig problems...development dysplasia, slipped upper femoral epiphysis, septic arthritis pt after laparoscopic cholecyctectomy with bile leaking from drain dg and another one with pancreatic head ca who failed ercp next stage of mg antibiotic prophylaxis questions cannot recall exactly but one was gas gangrene pathogen responsible for process again few questions one was surgeon after working with clean wound, perianal lesion, insect bite

opposite of relative risk.,.... numbers needed to -treat -sensitivity - DDH.. -SCFE -SEPTIC Arthritis -perthes -NERVE supply of pernieum -pulmonary artery branchial arch -nucleolus pulposes causing disc prolapse -pt with stiff back and limited expansion.... anklyosing spondilitis - p with prominent sacrum spondylolithesis -stupid question about blood groups -MCL -mm tear

lumber puncture - 1st structure femoral blood sampling land mark compartment syndrome hip extensor

the last emq regarding men with gynaecomastia. dg function of iliopsoas.. which structure will be injured during chest drainage through 5th intercostal on midaxillary line.. which nerve is in the posterior triangle of the neck...spinal accessory nerve was the answer transpyloric plane level...l1 pt with loss of anal tone with conus medullaris compression which dermatome will be affected...s2 s3 s4 3questions on gcs calculation...one was no motor no sensor no verbal so answer was 3. another one 14. questions regarding ankle brachial pressure...the db one was the one >1 ulcers and arterial ds 0,2 chronic venous ischaemia 0.7 and one more can't recall one q regarding assosiations of polyarteriitis nodosa... question about sinoatrial node another one which structure can be auscultated on 2nd spaceleft sternal border...pulmonary valve

A 10 year old boy is with symptoms of right knee pain. for the past 3 months and the pain typically lasts for several hours. On examination he walks with an antalgic gait and has apparent right leg shortening Perthes structure medial to femoral hernia Lacunar lig

 

 

MRCS 2012 sept part A

part a paper 2 patient travel to zembabwi fever nausea patient underwent op possibly decrease immunity + pneumonitis options CMV

h B v c d a hiv if u know answer?

 

Some  neuro  q-­‐    -­‐-­‐-­‐man  with  some  eye  sign  .  Diplopia-­‐-­‐o/e  3rd  n  6th  CN  palsy  with  forehead  paraesthesia  -­‐  the  ans  will  be  cavernous  sinus  lession  but  i  put  something  else  .  Same  que  is  in  passmedicine.  

 

-­‐ 70  yr  old  man  with  hemiballism,  better  when  asleep  -­‐  shoud  be  subthamic  nucleaus  but  i  don't  remeber  if  it  was  in  the  ans  because  i  ticked  red  nucleaus  again  wrong  sob  sob..    -­‐upper  limb  '  weak  abductor  pollicis  longus  or  brevis  with  decreased  sensation  of  index  finger  -­‐-­‐  ?  Ans    -­‐  another  diplopia  que  -­‐  that  was  recurrent  episode  of  self  limiting  diplopia.  O/e  ptosis  and  some  other  eye  movement  problem  well  i  don't  recall  the  ans  for  this  i  think  MS/  MD  was  among  them.    -­‐headache  +vomiting  for  2/7,  low  BP  on  presentation  .  I  think  there  was  3  nerve  palsy  again  -­‐  ?.  Could  it  be  pituatary  apoplexy  well  no  recall  of  ans  i  think  imight  have  done  wrong    -­‐some  limb  weakness  with  post  hypotension  -­‐  GBS  (  i  think  somebody  already  mentioned  this  Q    -­‐homonemous  quadrantonopia  one      -­‐obese  lady  with  headahce,  false  localising  signs  ,  high  BP  abt  169  sys-­‐?  IICH      -­‐galactorrperoa  with  hogh  prolactin  -­‐  which  drug  -­‐  ??  Metoclopramide-­‐-­‐  pharma  though      -­‐HIV  cerebral  involvement  what  will  differentiate  cryptococcus  frm  toxoplasmosis-­‐-­‐  ??  I  put  CT  but  the  CT  finding  might  be  similar  in  both  so  wonder  what  was  the  ans.—  

upper  limb  '  weak  abductor  pollicis  longus  or  brevis  with  decreased  sensation  of  index  finger  -­‐-­‐  Sensory  Loss  In  C6  Dermatomes+Abductor  Pollaces  Weak    night  pain  ,relieved  by  shaking  arm  etc    ?    A  C6  Entrapment  Neuropathy    B  carpal  tunal  syndrome    C  thoracic  outlet  syndrome    D  cervical  rib    E  oat  cell  carcinoma  

1. Rx  for  chlamidia  in  pregnancy  -­‐  erythromyci      2.  HIV  pt  with  CD  count  300-­‐  start  HAART    3.  Ix  to  confirm  post  bowel  surgery  bile  acid  ind  diarrhoea-­‐??  Sehcat    4.  young  pt  with  RA-­‐lower  limb  -­‐  sensory  loss  dorsum  of  foot  with  weak  dorsiflexion  -­‐  ??  mono    5.  A  patient  with  partial  third  and  fourth  nerve  palsy  right  with  absent  sensations  on  ipsilateral  forehead..site  of  lesion..midbrain,  orbit,  cavernous  sinus,  brainstem  ???    6.  cystic  fibrosis  which  chromosome  Cftr  Gene  In  Cystic  Fibrosis-­‐Code  For  Amino  Acid    7.  lady  with  neck  pain  post  fall  in  past  ..some  arm  weekness      8.  asthma  next  treatment  -­‐  IgE  level  given  prednisolone    9.  SE  of  fenesteride  –  gynaecomastia    10.  middle  age  guy  with  recurrent  ulcers  on  OGD  while  on  Max  dose  PPI-­‐  next  IX-­‐??  Gastrin  level      11.  prone  to  miscarriega-­‐  AB  -­‐  anti  b2  glycoprotein.    12.  light  reception  photopsin    13.  UC-­‐  goblet  cell  depletion    14.  Papules  And  Vesicles  On  Extensors  With  Itching  :  Dermatitis  Herpatiformis    15.  Polygonal  Voilaciouse  Papules  Then  Plaque  Eruptions  :  Lichen  Planus    16.  Picture  Of  Jaundice  Hepatospenomagaly  With  Lymphnode  Malaria  Or  Hiv  Seroconversion  (Ip  Was  4  Month  But  Pt  Have  Lyphadenopathy  So  I  Choose  Hiv  Sero  Conversion    17.  Sumatriptan  5ht1a  Agonist    18.  Infective  Endocarditis  By  Staph.Aureus:  Penicillin  Allergic  So  Answer  Would  Be  Vancomycin    19.  Tpo  Positive  +  Goiter  +Tsh  Low  =Grave  Ds  ?????    20.  Thyroid  Carcinoma  Causing  Laryngeal  N  Palsy  stridor    Anaplastic  Carcinoma    21.  Sick  Euthyroid  Syndrome  (Patient  In  Intensive  Care  Unit)    Tsh  n  T3  Low  T4  low    22.  Skin  Lesion  Voilaciouce  Pruritic  Lesion  On  Leg    23.  Porphyria  Cutis  Tarda    24.  Hyper  Prolactaemia  Drug  –Metaclopromide    25.  One  Male  Having  Rta  Compressive  Myelopathy  Level  T4  But  After  Few  Month  Level  Go  Up  To  T2  Cause  Post  Traumatic  Syrinx  ,Compression  Increase.....    26.  Malaria  Prophylaxis  –With  Ho  Seizure  –Atovaquine  +Proguinil    27.  Also  Post-­‐Transplant  Lymphoproliferative  Disorders  Caused  By-­‐-­‐-­‐-­‐-­‐  Ebv      28.  One  Case  Hyperbilurubinaemia  –Gilbert  Syndrome      29.  50  Shipyard  Worker  A  Case  Of  Sever  Left  Plueral  Effusion  Also  Calcific  Pleural  Plaqes  ,  Fever  ,  Pleural  Sample  Exudate  Lymphocytes  60%  With  

2%  Methothelial  Cells  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐  Tb  Or  Methothelioma  (  I  Am  More  With  Tb  As  Methoselial  Cells  Only  Exclude  Tb  If  More  Than  5%  And  Dosent  Indicate  Methothelioma  Also  Pleural  Plaqes  Is  Not  Premalignant,  Also  Fever  .)    30.  A  Case  Of  Shills  Fever  After  6  Monthes  Returning  From  West  Africa  -­‐-­‐-­‐Malaria  Ovale      31.  .A  Case  Of  Post  Mi  Artery-­‐Stemi  V1  -­‐  V2  -­‐-­‐-­‐-­‐-­‐  Circumflex  (In  15%  Postdesending)    32.  A  Case  2  Days  H/O  Headach  &  Visual  Loss  With  Paracentral  colour  Scotma  ?  Ms      33.  One  Case  Like  Face  Upper  limb,Lower  limb  Muscle  weakness  &  Wasting  With  Increase  DTR  ?Mnd      34.  A  Question  Recurrent  Weakness,  Sudden  Fall  Down  But  No  Loss  Of  Conceousness-­‐  cataplexy    35.  One  Case  Old  Age  But  Presented  Like  Ms  eye  squint    36.  elder  female  with  suicide  attempt:  embarassed  after  sum  medical  intervention:  highest  risk  of  suicide  with  in  2  weeks  :  most  probably  65  years  of  age  ??  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐  alcohol???    37.  Iron  Poisoning-­‐Treatment  There  Is  A  Q  About  Iron  Poisining  24  Hours  After  With  Sever  Manifestations  I  Guess  -­‐-­‐-­‐-­‐-­‐-­‐-­‐  Desferrioxamine    38.  Acut  Monoarthritis  –Aspiration  wrist    39.  Arthritis  Conjunctivitis  Clear  Urithal  Discharge  Travelling  +    -­‐-­‐Reactive  Arthritis      40.  Recurunt  Urticaria  Treatment  –Antihistamin,Steroid  Renitidin    41.  Ch  articaria  eye  oedema    42.  Post  Mi  Lip  Sweeling  Angioedema  Like  Due  Prindopril      43.  Fsgs-­‐  24  urine  0.9  gm  Proteinuria  Treatment  Ramipril    44.  20  male  proteinuria  minimal  change??    45.  Most  Common  Eye  Feature  Of  Wernickes  Encephalopathy    Option  Ophthalmoplasia  Nystagmus,    46.  Post-­‐Splenectomy  -­‐-­‐>howel  joly    47.  Sle  Is  Membranous  Gn  (Stage  5)  Because  Of  The  Nephrosis    48.  Achalasia  Investigation-­‐Manometry      49.  It  Was  Alcoholic  Liver  Disease  Due  To  High  Gama  Gt  And  In  Nash  Ast  To  Alt  Ratio  Is  Typically  Less  Than  One,  Which  In  This  Case  Is  More  Than  1....Plus  It  Is  Not  Associated  With  Gama  Gt    50.  Gastrin  Inceased  By-­‐Peptide      51.  Ankylosin  which  chromosome  6    52.  Ondensteron  Site  Of  Action-­‐Medula      53.  Enzyme  up  to  10  Day  Post  Mi-­‐-­‐-­‐-­‐Ldh    54.  Hocm-­‐  B  Myosin  heavy  chain    

55.  Turner  Syndome  +Intestinal  Obstruction??  Intussus/Crohn  Ds      56.  Pitz  jugar  s-­‐  AD    57.  Inflamatory  bowel  s  invest  -­‐-­‐-­‐-­‐C-­‐rp    58.  Metaanalysis-­‐-­‐-­‐-­‐Forest  Graph???    59.  Age  &  Bp  Variables-­‐  ?  Scatered  Graph    60.  Mody  Most  Common  glucokinase    61.  Hb  E,  beta  Thalacaemia  Trait@  Thala  Major  25%?    62.  Lmwh-­‐-­‐-­‐-­‐Factor  X  /  anti  t3  ???    63.  Yonge  Lady  S2  Loud  -­‐-­‐-­‐-­‐Sob  Syncope-­‐-­‐Family  Ho  -­‐-­‐Pah    64.  Homocysteinuria-­‐  Reduced  Activity  Of  Cystathione  Betasynthase.    65.  Post  renal  transplant  4  years  With  Reduced  25  Dihydroxy  Vit  D,  Increased  Pth  normal  c.CA  normal  kidney  -­‐Secondary  And  Tertiary  Hyperparathyroidism  ??      66.  Live  Attenuated  Vaccine-­‐  Yellow  Fever    67.  Neisseria  Gonorrhea-­‐  Aerobic  Diplococcus-­‐  Male  Urethritis      68.  To  exclude  Cushings-­‐  Overnight  Dexamethasone  Suppression  Test    69.  Essential  Tremor-­‐  Family  History+  -­‐  Propanalol      70.  Specificity=  890/950    71.  Acute  Episode  Of  Hematemesis-­‐  Terlipressin    72.  Long  Term  Prophylaxis  For  Gi  Bleed-­‐  Propanalol      73.  Angiodysplasia-­‐  aortic  stenosis      74.  .  Extrinsic  Allergic  Alveolitis-­‐  Hay    75.  Restless  Leg  Syndrome-­‐  Ropinirole      76.  Clopidogrel-­‐  Adp  Agonists    77.  Allergic  Reaction  Following  Food  Intake  –  Trypase    78.  Pda-­‐  Collapsing  Pulse    79.  Depression-­‐  Early  Morning  Wakening/  suicidal  thougts    80.  For  The  Contact  With  Afb  +Ev  TB  Mantox  Test  then  Cxr    81.  Recent  Immigration  From  Uganda  With  Multiple  Hypopigmented  Areas  And  Reduced  Sensation  -­‐  Leprosy.      82.  Uti  Treatment  In  Hosp  After  3  Days  Becomes  Agitated  -­‐  Delirium.      83.  Nodular  Lesion  On  temporal  telangectasic  Face  With  Pearly  Margine  =?Bcc=  -­‐Biopsy  true  cut  ??    84.  Lower  Zone  Fibrosis  =Asbestosis    85.  Decrease  Kco  Methotrexate  Pneumonitis    86.  Increase  Kco  Pulmonay  Hemorrage      87.  Recurrent  Oral  +Srotal  Ucer  =En=  Becets  Ds    88.  Hypercalcaemia-­‐-­‐-­‐-­‐-­‐-­‐  Thiazide    89.  Best  Evidence  =Metanalysis    

 90.  Face  desease  statistic  paired  t  test    91.  Intention  To  Treat-­‐  All  Included    92.  Methadon  -­‐Sudden  Death  -­‐Long  Qt  Syndrome    93.  Schizophrenia  Vs  cannabis  one    94.  teenage  with  hallucinosis  and  sum  other  complaint:  inatke  of  alcohol  100  units  and  regular  cannbinoid  user:  on  examination:  oriented  with  tym,  place:  cannabinoid  psychosis  or  alcoholic  but  alcohol  withdrawal  can  give  hallucinosis  not  by  itself  ??  paranoid  schizo  she  have  auditory  third  party  persecutory  i  thnk  it  is  1  rank  symptoms??  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐  Schizophrenia???    95.  Asymptomatic  Ealy  Latent  Syphlis  pregnant  Treatment-­‐  Penicilin    96.  Post  Temporal  Lobe  Surgery  -­‐Homonemous  Qudrintonopea    97.  Sensory  Loss  In  C6  index  finger  Dermatomes+Abductor  Pollaces  Weak  ?  C6  Entrapment  Neuropathy    98.  Pain  shoulder  then  lmnl  in  UL  Post  Viral  Neuralgic  Amyotrophy    99.  Choria-­‐Caudate  Nu      100.  Lady  Bmi  40  Short  Neck  Hypoxia  Leg  Edema=Osa/Obesity  Hypoventilation  Syndrome  

101.  Becet  Ds  Lg  Sweeling=Dvt      102.  Myoclonus-­‐-­‐Doc  Clonazipam/Valproat      103.  Rhabdomylysis  Responsible  =Simvastatin      104.  Lady  Polyurea  +Polydipsia  With  High  Blood  Na  +  High  Blood  Osmolality  +Urine  Na  Less  Then  +==?Diabetic  Incipidus    =mangement  ?Oral  Desmopressin  .Fluid  Restriction    105.  Hyponateremia  mild  hyperkalemia  high  urine  NA  -­‐-­‐-­‐-­‐-­‐Addison    106.  Azothiopurin  Befor  Start  Test  -­‐-­‐-­‐-­‐-­‐Tioprine  mt    107.  Digoxin  Loading  Dose  -­‐-­‐half  life    108.  Salbutamol  Oral  Vs  Inhalar  High  Bioavailibility  ????    109.  Complete  heart  block  +  Inf  Mi  2  hours  +Stable  pulse  50  appropriate  immediate  action=Pci    110.  Post  Alteplase  Bleeding  -­‐-­‐-­‐Ffp,  Prothrombin  Complex??    111.  Paroxism  svt-­‐  not  distressed  return  to  sinus  after  vagal  manage  Definate  Treatment  –vagal  manover  or  flecainide    112.  Lyme  Ds  Treatment  Penicilline  Allergy-­‐Doxycy    113.  Csf  finding  Vial  Meningitis    114.  Cause  Of  Wide  Qrs  During  Exercise  Test-­‐  In  Wpw  Syndrome-­‐?  Increase  Refractory  Of  Accessory  Pathway???    115.  Paget  Ds  With  Mri  +  Bone  Pain  Nsaids\Bisphosphonates    116.  Cisplatin  -­‐Side  Effect-­‐Peripheral  Neuropathy/?    117.  2  Sd  above  the  mean  =95%    118.  Female  With  Primary  Amenorrhoea  +Virulising=  Congenital  Adrenal  Hyperplasia=Investigation-­‐17  Oh  Progesterone      

119.  Acute  Mania-­‐-­‐-­‐lithium  Or  haloperidol    120.  RA  pt  rec  UTI  on  methotrexate  Apastic  Anemia  -­‐Trimethoprim  ??    121.  Myelofibrosis-­‐Tear  Drop  Cell      122.  Diabetic  Pt  With  Hypokalaemia  Hyperchloramic  Acidosis-­‐Renal  Tubular  Acidosis    123.  In  transplanted  PT  A  Non  Responding  Pt  Of  Febrile  Neutropenia  4  days  ???  Candida  Fungemia    124.  Tronchataric  Bursitis    ?/    125.  After  3  days  of  Treatment  Of  Temporal  Artitis  neutrophilia  Steroid  Induced  Leucocystois    126.  Rest  Less  Leg..  Ropironole..    127.  Abdo  Pain  And  Tenesmus  Rectal  Exam  Normal  –  Sigmoidoscopy//Colonoscopy    128.  Heart  Failure  Already  On  Furosemide,  Ace,  B.  Blocker,  Aspirin  To  Optimise  Add  –  Spironolactone    129.  Pancreas  Ca  Treated  With  Chemo  -­‐  Monitor  Tumour  Marker  Ca  19.9    130.  Woman  With  T2dm  And  Copd  Exacerbation,  Lactate  Normal,  Abg  Ph  7.30,  Pco2  10,  Po2  9,  H+  50  -­‐  Acute  On  Chronic  Resp  Acidosis.    131.  Advanced  liver  d  raised  creat  ,  urine  NA  below  5  off  diuretic  Hepatorenal  $  pathogenesis  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐renal  vascular  vasoconstriction    132.  Man  previous  MI  done  CATH  4  monthes  mottled  skin  levido  reticularis  -­‐-­‐-­‐-­‐-­‐  cholesterol  emboli    133.  Woman  With  Recurrent  Collapse  And  Wt  Gain  low  c  peptide  -­‐-­‐-­‐-­‐  -­‐  Insulin  Overuse.    134.  Treatment  Of  Choice  replace  Sod  Valproate  to  Lamotrigine..  ??  Ans    135.  Locked  In  Syndrome  Lesion  In  man  Has  Vertical  Gaze  Paralysis  Plus  Quadriplegia  .  Can  Not  Wake  Up  After  Intubation  What  Is  Teh  Cause?  -­‐-­‐-­‐-­‐-­‐-­‐  Pons?  (Ventral  Pons)    136.  Lady  Develops  Abdominal  Pain  Followed  By  Loc  And  Developes  Lip  Smacking  And  Staring  Where  Is  Lesion?  -­‐-­‐-­‐-­‐-­‐  Temporal    137.  18  Yr  Female  Running  Behind  Bus  Sudden  Death  Girl  Running  After  Bus,  There  Was  No  Option  As  Prolonged  Qt  Interval,  There  Was  Only  Arythmia,  Seizure,  Vasovagal,  Cardiogenic...So  It  Would  Be  Cardiogenic..-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐.Hocm  Cardiodenic  Syncope    138.  Vt  Drud  Contraindicated..  Verapamil    139.  P53=  Cell  Cycle  Delays/Apoptosis    140.  Stressed  Lady  Recently  Stopped  All  Meds  ?  Diazepalm  Withdrawel/  Thyrotoxicosis    141.  Pulmonary  Surfactant-­‐-­‐-­‐-­‐-­‐-­‐-­‐phospholipid    142.  Osteoporosis  In  Males-­‐Testosterone    143.  Oral+Genital  Ulcers-­‐Behcets      144.  Cryoglobulinemia-­‐Hep  C    145.  Hereditory  Angioedema-­‐,Ci  Esterase,  C4  Level  In  Between  Attacks    146.  Fragile  x  chromosome  female  carier  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐  50%    147.  Ifosfamide-­‐Mesna  To  Prevent  H  Cystitis    148.  No  Surgery  For  Ca  Lung  If  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐  vocal  cord  Paralysis    

149.  Pulm  Emb-­‐CTPA    150.  Burkitts  lymphoma-­‐  Tumor  Lysis  Syn    151.  Rh  Arthritis  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐Anti  Cyclic  Citrullinated  Abs-­‐    152.  Amiodarone-­‐K  Channel    153.  Factor  5  Leiden-­‐Activated  Protein  C    154.  Strep  Bovis  bacterimia-­‐Colorectal  Ca    155.  A  male  with  hemoptysis  and  renal  failure..renal  biopsy  shows  cresentic  glomerulonephritis  with  linear  igG  deposition...which  antibody  to  order  to  confirm  diagnosis.  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐Anti-­‐Gbm      156.  Stag  Horn  Calculi-­‐  Composition  Mg  Ammm  Phosphate    157.  anorexia  nervosa  hypokalemia  refeeding  syndrome  what  to  look  for  next  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐hypophosphatemia    158.  Pcp  treatment  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐cotrimexazole    159.  Traveler  shocked  88/50  what  to  do  next  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐isotonic  saline    160.  young  male  recurrent  hemoptysis  upper  lope  lung  collapse  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐  carcinoid  tumor    161.  swollen  knee  xray  chondrcalcinosis  sterile-­‐  pseudogout    162.  5  attacks  of  gout  in  12  monthes  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐allopurinanol    163.  Young  female  RA  to  start  methotrexate  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐contraception    164.  increasing  dyspnea,  low  transer  factor-­‐  emphysema    165.  toxoplasmosis  from  Cryptococcus  in  HIV  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐Ct  scan  mass  effect????  166.  A  72  yr  old  man  with  acute  mono  ocular  visual  loss.  On  exam  pale  optic  disk  in  affected  eye..diagnosis...-­‐0-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐  giant  cell  artiritis,    167.  A  patient  with  sudden  onset  occipital  headche  and  vomiting..on  exam  has  gcs  15,  and  neck  stiffness..ct  brain  normal...next  investigation...-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐.csf    168.  What  does  a  codon  encode...-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐  aminoacid    169.  Patient  on  LAnsoprazole  X  2yrs,  decreased  platelet  15000  and  megarkaryocyte  in  peripheral  smear  Dx:  ITP    170.  young  lady  ans  can  be  vasovagal  as  recovery  was  very  rapid    171.  female  patient  with  difficulty  climbing  stairs  weekness  of  proximal  and  distal  muscles  of  limbs  no  sensory  deficit  deep  tendon  reflexes  absent  and  postural  drop  in  blood  pressure  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐GB  $    172.  A  hypothyroid  female  on  thyroxin  with  adequate  control  suffers  MI..she  is  thrombolysed  and  discharged  on  aspirin,  clopidogrel,  simvastatin,  ferrous  sulfate,  ramipril,..  6  weeks  later  she  comes  back  with  increased  TSH..which  drug  has  interacted  with  thyroxin...-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐iron  sulphate    173.  Spontaneous  pneumothorax  scenario...xray  shows  3.5  cm  pneumothorax  in  left  lateral  side...mangement...-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐  needle  thoracocentesis?????    174.  which  food  product  has  the  maximum  amount  of  calories/kg??  Ans:  white  wheat    175.  giant  v  wave  and  systolic  murmur?  Ventr  pre  excitation  Ans:  Ebstein  anomaly    176.  old  male  gait  disturbance  ataxia  few  hours  deterioration  conscious  bilateral  planter  bp  rises  190/100  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐herniation  brain  stem    177.  What  causes  pul  vasodilatn  in  healthy  adult?  Ans:  Postracyclin    178.  another  diplopia  que  -­‐  that  was  recurrent  episode  of  self  limiting  diplopia.  O/e  ptosis  and  some  other  eye  movement  problem  well  i  don't  recall  the  ans  for  this  i  think  MS/  MD  was  among  them.    

179.  Complete  heart  block-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐rt  coronary  artery    180.  Abdominal  pain,  bleeding-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐ulcerative  colitis    181.  Febril  neutropenia  what  first  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐broad  spectrum  antibiotics    182.  dm,  no  family  history,  bmi  high  :  mechanism  insulin  resistance  and  weight  loss  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐increased  catecholamine??????    183.  A  question  about  somatization  syndrome    184.  45  year  old  female  tlc  100  000  splenomegaly  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐chronic  myloid  leukemia    185.  Guillan  Barre  syndrome:  check  VITAL  CAPACITY.    186.  Albumin  low,  total  protein  high  _  myeloma  -­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐plasma  protein  electrophoresis).    187.  Young  femal  have  completed  chemotheraby  6  monthes  ago  presented  with  hip  pain-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐avascular  necrosis  of  the  hip    188.  A  case  of  hemolytic  uremic  syndrome  (low  platelet  and  raised  creat  post  diarrhea)-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐  E  coli  O157:H7  190.  Chances  of  inherting  cystic  fibrosis    191.  Strep.  Pneumonia-­‐  most  common  cause  of  pneumonia    192.  Tuberculosis  mediated  by-­‐  T  cells.    193.  Boy  e  recurrent  abscess  and  family  hx  of  a  cousin  who  died  of  a  chest  infectio-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐-­‐  neutrophil  defect    194.  Addison’s  best  test-­‐  short  syncathen  test    195.  Ptyriasis  versiclour  man  came  from  vacation  

 

 

Mrcs part a april 2012

1. Warm peripheries…..Septic shock 2. NA in septic shock 3. Immediate response to blood loss……sympathetic response 4. Angiotensin II …vasoconstriction 5. Response to shock…..renin angiotensin system 6. Hypovolemic shock 7. Septic shock 8. Neurogenic shock 9. Latex allergy 10. Stroke volume….70 ml/min 11. Paired t test 12. Unpaired t test 13. Out come audit 14. Structure audit 15. Process audit 16. ……audit

17. Intussuception 18. Juvenile rectal polyp 19. Anal fissure 20. Inflammatory bowel disease 21. Unilateral cleft lip…….maxillary process and median nasal process 22. Posterior urethral valves 23. Urethral stricture 24. Bladder cancer 25. Proteus….renal stone 26. Glomerulonephritis 27. Pre renal failure 28. 75 kg, 22% burns……5 to 7 L/24 hours electrolyte containing fluid 29. 85 kg, 19% burns……5 to 7 l/24 hours electrolyte containg fluid 30. Full thickness bur…..split thickness graft 31. Basal cell ca…….advancement flap 32. Wound debridement and closure 33. Wound debridement and secondary intention healing 34. Necrositing fasciitis 35. Hirudinitis suppurativa 36. Clostridial myonecrosis 37. Serum calcium high, phoapous high, pth high, renal failure…..Teritiary hyperparathyroidism 38. Pth function….activation of 1,25 hydroxy calciferol 39. Conn syndrome….hypervolumia 40. Adrenal 1.5 cm mass….nonfunctioning adrenal adenoma 41. Lactic acid……anaerobic glycolysis 42. Metabolic alkalosis…..nasogastric aspirate 43. Metabolic acidosis….DKA 44. COPD…. Respiratory acidosis 45. COPD….respiratory acidosis 46. COPD…..type 2 respiratory failure 47. Pulmonary embolism….respiratory alkalosis 48. Increased fev1 and fvc……COPD/asthma/fibrosing alveolitis/bronchiectasis/pte 49. Lung volume on spirometry Maximum inspiration to maximum expiration……Maximum voluntary ventilation 50. During CPB, axillary artery exposure……structure not seen…axillary lymphnoodes/ 51. Left internal thoracic artery branch of subclavian artery…..immediate branch at origin 52. Hemopneumothorax drainage……5th ics mid axillary line 53. Pericardial tamponade drainage…..no answer 54. Type of lung cancer in heavy smoker, hilar mass, massive mediastinal

nodal mass, histologically….small cell ca 55. Chronic smoker….bronchial metaplasis…reversible nonstratified squamous epithelium 56. Peutz jaugher’s syndrome 57. Familial adenomatous polyposis 58. Colonic polyp is due to…..apoptosis/calcification/degeneration/metaplasia/dysplasia 59. Testicular mass, normal tumor markers, histology….classic seminoma 60. Testicular injury, painless testicular mass, left supraclavicular node…..seminoma 61. Brest cancer tumor marker…no answer 62. Testicular malignant teratoma tumor marker…afp 63. Metastatic colon cancer tumor marker…..cea 64. Hepatocellular cancer…afp 65. Rectal cancer 11 cm from anal verge….anterior resection 66. Peritonitis due to perfoarated diverticular disease….hartman operation 67. Testicular descent…gobernaculam 68. Testicular torsion 69. Neonatal hydrocele….processus vaginalis 70. Anal intra epithelial neoplasia 71. Cancer at anal verge….inguinal lymphnodes 72. Aortic aneurysm near SMA pushing LRV  

-­‐ ICD  insertion  site-­‐  man  with  heamopneumothx,  immediate  management  man  with  cardiac  temponade(site  of  pericardiocentesis??)    -­‐aortic  hiatus  level    -­‐  sportsman  sudden  death,  Intra  cerebral  hge  whats  the  type?  SAhge    -­‐  Gunshot  injury  back  of  distal  thigh,  what  is  most  lateral  structure  Pop  fossa?    -­‐  A  man  sudden  GCS  15,  head  injury  GCS  8  later,  coma,  rt  sided  pupil  fixed.-­‐  extradural  rt  or  lt?    -­‐  A  man  poor  straem  urine,  sense  of  incomplete  evacuation  for  

last  6month,  H/O  UTI  featuring  urethral  pus  4yrs  back-­‐  dx  BEP/urethral  stenosis?    -­‐  Injury  of  nerve-­‐  posterior  humerus  approach,  ankle  medial  approach,  SSV  popliteal  approach    -­‐  raised  rounded  lesion  at  face.    -­‐  tumor  marker-­‐  teratoma,  HCC,  Melanoma,  rectum,  breast    -­‐  Doppler  in  various  types  of  vericose  veins  4themes  were  there,  i  think  one  of  the  tricky  questions    -­‐  smoker,  mechanism  of  ca  in  lung-­‐  irreversible  damage  to  tissue?    -­‐  esopagus  barrets  lower  part-­‐  type  of  histology    -­‐  Ca  esophagus  upper  2/3  part  type  of  hisyology  -­‐>  Squamous    -­‐  8cm  Incision  from  deltopectoral  groove  to  midline  which  structure  will  not  injure-­‐  ax  art/  P.major/Br.plx  trunk/cephalic  v./shoulder  joint  capsule    -­‐  hematuria,  lesion  at  distal  femur-­‐  wheres  the  lesion?    -­‐  frank  hematuria  hemoglobin  18.8  other  parameters  ok-­‐  dx    -­‐  corrected  ca  high,  PTH  high-­‐  dx?    -­‐  wt  loss,  hot  intolerance,  fine  tremor  TFT  features    -­‐  Medullary  carcinoma  urinary  marker    -­‐  fibroadenoma    -­‐  green  thick  discharge  for  4months  no  other  lesion  specifically-­‐  dx    -­‐  Submandibular  gland  excision  which  nerve  injured?  Ligual  (sensory)  Hypoglossyal  (motor)    

-­‐  Proteus  infection  in  urine  which  will  be  dx.    -­‐  Intention  tremor,  cogwheel  rigidity,  flaccid  paralysis  lesion  site    -­‐  winged  scapula,  which  muscle  involved-­‐  Serratus  anterior    -­‐  injnury  to  shoulder  cant  shrug  which  nerve?  Accessory    -­‐  12  yr  old  girl  knee  pain,  no  other  findings,  hip  is  externally  rotated  when  knee  is  flexed  -­‐  dx?    -­‐  old  man  do  cycling  comfortably,  but  find  difficulty  downstair  going.  dx    -­‐  AAA  where  is  the  defect?-­‐intimal  collagen  or  elastin?  Adventitial  collagen  or  elastin?    -­‐  Audit  type?  Structure  audit,  outcome  audit,  incidence  audit  another  was  there  I  forgot    -­‐  Paired  t  test,  unpaired  t  test,  man  whitney  u  2  questions  there  I  marked  both  of  them  paired  t  test…    -­‐  Median  nerve  relation  at  arm.    -­‐  Cut  injury  front  of  elbow  joint  which  most  lateral  structure  will  be  injured?    -­‐  Alcoholic,  hematemesis,  OGD  shows  erythematous  lesion  lower  part  esophagus  Dx?    -­‐  Dispnoea,  tachycardia  after  vomiting  dx?    -­‐  Alcoholic,  hematemesis  Dx—I  think  it  was  varices    -­‐  Jaundice  can  be  czed  by-­‐  HIV,  HPB,  HBV?  Most  eziest  question    -­‐  GCS  was  15,  now  8  pupil  rt  side  dilated,  poor  reponse  to  light  what  investigation  next  -­‐-­‐-­‐-­‐-­‐  CT/  CPP?    -­‐  Pt.  with  confusion,  weakness  rt  side  what  investigation  next  -­‐-­‐

-­‐-­‐-­‐  CT/  CPP?  -­‐  Morphine  acts  on  which  receptor?  µ  (central  and  peripheral)  -­‐  causes  analgesia,  miosis,  decreased  gut  motility    -­‐  Pt  with  pain,  swelling  of  thyroid  gland,  dx    -­‐  Pt  with  wt  loss,  CXR  shows  shadows  hilar  area,  cervical  lymphadenopathy…dx    -­‐  One  question  of  resp,  alkalosis..    -­‐  A  baby  with  hydronephrosis,  uremia  present…  dx  posterior  urethtral  valve?    -­‐  A  pt  with  ACEi  pre  op,  now  urine  output10ml  last  2hrs  what  will  be  next  plan-­‐stop  ACEi/  fluid  challenge/  furosemide?    -­‐  2  questions  from  one  chart  thyroid-­‐-­‐-­‐-­‐-­‐thyroid  bilat  weakness  another  one  I  forgot    -­‐  A  girl  with  smell  of  ketone  body…    -­‐  Pancreatic  ca  diagnosed,  stool  fixed  to  commode  ,  not  removed  with  flush…  which  enz  problem?  Lipase    -­‐  2themes  from  breast    -­‐  Shock  feature  –  hypovolaemia,  cardiogenic,  septic,  neurogenic    -­‐  Post  op  pt  @  ITU  6  units  BT  done,  platelet  count  40  others  ok  …  DIC?    -­‐  Homonimous  hemianopia  wheres  the  lesion.    -­‐  Pituitary  lesion  what  will  be  effect?  2alternate  questions  were….    -­‐  Root  value  of  urethral  sphincter?    -­‐  Lumber  punctute  -­‐-­‐-­‐  S1,  S2,  S3,  S4,  S5…  can  somebody  please  clearly  remember  the  question  please?    

-­‐  Renal  vein  lt.  side  will  obstacled  by  one  of  the  arterial  structure  infront  what  was  that?    -­‐  One  man  with  RTA  apparently  stable,  collapsed  at  A&E  after  catheter  done…  latex  hypersensitivity?    -­‐  CXR  shows  a  metallic  prosthesis  behind  sternum  what  was  that?  Aortic  valve,  mitral  valve,  tricuspid  valve?    -­‐  Which  structure  is  not  behind  rt  kidney?  Transverses.  Abd?    -­‐  ABPI—resting  pain  1  theme  and  man  can  walk  upto  500-­‐600  meter  then  pain  what  will  be  the  index  <0.4/  0.4-­‐0.6/0.6-­‐0.8/>1    -­‐  Skin  graft  theme-­‐-­‐-­‐-­‐  dog  bite  to  nose  damaged  away-­‐-­‐-­‐-­‐another  theme  was  6  cm  wide  lacerated  wound  at  scalp  -­‐-­‐-­‐  another  theme  was  1cm  woung  leg  -­‐-­‐-­‐advancement  flap,  leave  it  for2ndary,  primary  closure    -­‐  Which  fluid  is  most  electrolytes  reach?  Hartmanns’?  -­‐  Burn  fluid  management  2  theme  but  they  didn’t  give  any  clue  to  calculate  %  of  burn…  I  just  answered  it  with  guess  work…    -­‐  A  boy  10  years  failure  to  thrive,  wt  loss,  bloody  diarrhea,  -­‐-­‐-­‐  inflammatory  bowel  diseae/  intussuss/meckel’s/    -­‐  A  boy  pain  ful  defeacation,  few  drop  blood  on  the  pan,,,,  anul  fissure..    -­‐  A  boy  6  yrs,  parents  found,  strawberry  color  strurture  coming  out  thru  anus  after  defeacation  dx?    -­‐  Movable  carcinoma,  6cm  from  anal  verge—AR  or  reposition  proctocolectomy  which  will  be  the  ans?  I  gave  AR…but  I  think  ans  will  be  the2nd  one..    -­‐  Wkness  of  elbow  extention,  sensation  loss  over  1st  digit  dorsum  which  nerve  involve?    -­‐  Loss  of  sensation  over  hypothenar  eminence,  medial  1  and  half  finger  h/o  injury  at  lower  Humerus  at  childhood,  which  

nerve  involved?    -­‐  Sjogrens  syndrome,  pleomorphic,  warthin’s  3themes    -­‐  CXR  shows  lower  esophageal  narrowing,  h/o  dysphagia  ocaasional,  chest  pain  24  yrs….  Achalasia?    -­‐  Facial  muscle  from  which  branchial  arch?    -­‐  A  baby  boy  with  inguinal  small  swelling  4cm,  swells  up  day  time  but  reduced  at  night  when  he  lie  down…  no  other  symptoms…  persistant  p.vaginalis?    -­‐  A  women  swelling  pain  lateral  to  pubic  tubercle….    -­‐  Weakness  front  of  thigh  unable  to  extend  knee..    -­‐  Lateral  side  thigh  an  area  of  around  a  palm  size  which  nerve  involved    -­‐  A  women  after  child  birth  by  NVD  which  nerve  is  injured  to  cause  wkness  of  anal  sphincter  forced  her  to  experience  stool  incontinence?    -­‐  After  birth  cleft  lip  rt  upper  lip  what  is  the  defect?    -­‐  To  check  whether  its  UMNL  or  LMNL  after  facial  palsy  what  the  doctor  ask  the  pt  to  do?    -­‐  To  test  the  posterior  compartment  muscle  of  leg  ask  the  pt  to  do  what?  Eversion  of  foot/  invertion    -­‐  RTA  open  fracture  of  proximal  radiaus  ulna,  complaining  pain  and  numbness  of  forearm-­‐-­‐-­‐what  to  do  fasciotomy/  ORIF/  skeletal  traction/Ex  fix    -­‐  RTA  fractute  humerus  open  fracture  what  to  do?  fasciotomy/  ORIF/  skeletal  traction/Ex  fix      -­‐  Akle  planter  flexion  root  value…    

-­‐  Which  term  used  to  indicate  the  prognosis  is  bad  of  a  breast  carcinoma-­‐  size/  grade/  LN  involvement/  ER  positive    -­‐  Which  are  in  direct  contact  of  Navicular  bone?    -­‐  Old  man  65  yrs..  playing  ,  sudden  pain  at  calf  muscle.  Squeezing  of  calf  muscle  cz  passive  planter  flexion  of  ankle  joint  where  is  the  defect?    -­‐  While  playing  sudden  pain  at  calf….may  be  rupture  backer’s  cyst  will  be  the  ans.    -­‐  while  playing  pain  at  back  of  thigh  unable  to  flex  knee  joint-­‐-­‐-­‐-­‐  biceps  femoris  injury/  semimembranosus/semitendinosus/gracilis    -­‐  Pain  at  buttock,  impotence  where  is  the  block:  both  common  iliac  /  common  iliac/  ext  iliac/  IIA    -­‐  3theme  from  breast  ca    -­‐A  man  on  warin,  unconscious...  INR  2.1  Dx...  cerebral  hge    

-­‐ Hernia  operation  scrotal  numbness,  which  nerve  involve?    -­‐  Caecal  mass  theme  3    -­‐  Injury  at  wrist,  hand  placed  on  the  table,  thumb  cannot  be  make  abduct  90degree  on  the  hand….  Which  muscle  is  involved....  opponens?    -­‐  Scaphoid  bone  blood  supply  

 

1) lumbar  canal  stenosis-­‐  old  man  with  pain  limbs  on  walking,  bicycling  he  feels  alright-­‐-­‐-­‐-­‐this  was  also  repeated  in  theme  in  emq    2)  morphine  acts  on  mu  receptors    3)  theme  on  dysphagia-­‐  old  lady  with  burning  chest  ,more  at  night  ,feels  ok  on  sitting  upright,  x  ray  shows  stricture  lower  

oesophagus-­‐-­‐  achalasia,  gerd,  ca  oesophagus,  hiatus  hernia,  motility  disorder    4)  drug  of  choice  for  carcinoid  syndrome-­‐-­‐  octreotide,  somatostatin  etc    5)s  themes  on  thyroid  pathology-­‐  1)a  specimen  with  oxyphil  cells  and  scanty  throid  colloid  and  another  with  numerous  lymphocytes—  

lumbar  cistern  termination  :  s2  While  playing  sudden  pain  at  calf….+ve  homan  sign  ....DVT    UMNL  or  LMNL  after  facial  palsy  .....  upper  brows  winged  scapula,  which  muscle  involved....  serratus  ant.  Audit  Structure  The  availability  and  organisation  of  resources  and  personnel.  •  Process  The  activities  undertaken,  that  is,  what  is  done  with  the  service’s  resources.  •  Outcome  The  effect  of  the  activities  on  the  ‘health/well-­‐being’  of  the  service  user,  that  is,  changes  for  the  individual  which  can  be  attributed  to  the  clinical  intervention  they  received.  

 

MRCS part A September 2011

questions: 1- Appearance of skull Xray in MM: Lytic lesions 2- High Ca, High ALP, normal PO4 : 1ry hyperparathyroidism 3-Artery liable to injury during ligation at SFJ (I did it wrong, but I think the correct answer is superficial external pudendal a) 4- Lesion at anal verge, what is the LNs involved 5- Lytic metastatic bone lesion, what is most probable primary :breast 6-pathology associated with Crohn's disease :granulomatous inflammation. 7- Cells forming giant cells: macrophage 8- Colorectal Ca going through to mesentry with 2 LNs involved : Duke C 9- Pancreatic tumor with groin and buttock rash seen at dermatology : glucagonoma 10- Athlete died during footbal game: ?intercerbral Hge/? subarachnoid

hge 11-artery involved with patient coming with leg weakness: ? ACA 12- tendon involved in anatomical snuff box: extensor pollicis brevis 13- Patient with enlarged lateral and 3rd ventricles: stenosis at aquecuct of Sylvius. 14- Thyroid carcinoma with cervical LNs metastasis: papillary thyroid CA. 15- Intracranial bleeding with unilateral dilated fixed pupil: trantentorial herniation. 16- Deprssed skull fracture at vertex, which vein involved : SSS 17- Nerve injured in posterior triangle of the neck: spinal accessory N. 18- Golf player had blow to the face, probable EO muscle injury, which investigation: US 19- Inhaled FB, where it will settle: right lower lobe 20- Nerves supplying anal sphincter: S2,3,4 21- Catheterizing a male, what is the tightest part: membranous urethra 22- perinural parotid tumour: ?pleomorphic adenoma 23- Slim tall pregnant lady with chest pain: ? aortic dissection (probable Marfan syndrome) 24- prgnant lady with shock: ? acute massive PE 25- pregnant lady with pleuritic chest pain, haemoptysis: ? pulmonary infarction 26- 19 years old boy post appendecectomy, poor UOP: 500 mls gelo 27- Post stroke gentleman, day 7, not eating: consider PEG tube 28- daily requirment post op patient: 1 L saline+ 1.5 L hartmann's 29- 45 years old gentlema, known Barrett's oes, high grade dysplasia : ? for oesophagectomy 30- Advanced Ca oes with solitar liver met:? stent 31- A lady with known iron defeciency and dysphagia oes varices 32- young lady, chest pain, normal ECG and enzymes: oes spasm 33- Newborn, respiratory distress, trachea shifted, displaced cardiac apex: ? congenital diaphragmatic hernia 34-Newborn, cyanotic, improves with crying: ? subglottic stenosis 35- Newborn, unable to pass NG, air in stomach: congenital oes atresia with tracheo-oes fistula. 36- embryonic origin of right and left pul arteries. 37- Tumour marker for medullary thyroid CA: calcitonin 38- Tumour marker for pheochromocytoma: VMA 39- Prolonged constipation, LIF pain, fever: diverticulitis 40- Drug used in ITU , important in septic shock: noradrenaline 41- Post thyroidectomy teacher, unable to sing: unilateral external laryngeal N injury 42- Vomitting, abdo pain, swelling at reversal of colostomy site:

obstructed incisional hernia 43- Pfannenstiel incision, which layer divided: ? rectus sheath 44- Upper midline incision, which layer divided: linea alba 45- Bullet going through junction of linea semilunaris and costal margin on right side, which structure injured: GB 46- Structure at medial part of femoral ring: lacunar lig 47- pu;sating neck swelling, confirmed by angio: carotid a aneurysm 48- Enlarged tender liver, multiple lesions, calcification: ? hydatid disease 49- 11 years old child, painful scrotal 3 mm swelling, separated from testis: torsion hydatid of Morgagni 50- Man acute scrotum, oedematous, tender hemiscrotum: ? testicular torsion 51- big painless scrotal swelling: hydrocele 52- painless swelling above testis: ?epidydimal cyst 53- 26 years old male, rapidly growing swelling within testis: ? testicular tumor 54- site of ectopic testis: ? base of penis 55- footballer with twisting injury and tenderness just proximal to medial part of knee joint: ? medial collateral lig injury 56- structure felt in PV anteriorly at level fo cervix:? dome of bladder/ ? base of bladder 57- Artery injured in upper chest wall below clavicle: ? thoracoacromial a.  

1-­‐ Structure  liable  to  injury  during  fibulectomy:  ?peroneal  artery    2-­‐  Recoprical  of  absolute  risk:  ?number  needed  to  treat    3-­‐  Sensitivity  definition    4-­‐  Difference  between  control  and  experiment:  ?absolute  risk    5-­‐  Type  of  fracture  in  child:  ?greenstick    6-­‐  Type  of  fracture  in  twisting  injury  of  tibia:  ?spiral    7-­‐  Type  of  fracture  in  femur  after  car  accident:  I  did  it  oblique  (but  I  think  correct  answer  is  transverse)    8-­‐  Type  of  fracture  in  metastatic/osteoporotic  bone:  ?transverse    9-­‐  Hyperechoic  lesion  in  liver:  ?hemangioma    10-­‐  Cirrhotic  and  hep  C  liver:  hepatocellular  carcinoma    11-­‐  Another  liver  lesion  (can’t  remember  its  description):  ?metastases    12-­‐  Newborn  with  cyanosis,  improves  with  crying:  ?choanal  atresia    

13-­‐  Post  thyroidectomy  unable  to  cough  and  clear  throat:  superior  laryngeal  n    14-­‐  Neck  swelling  that  appeared  before  infront  of  sternomastoid:  branchial  cyst    15-­‐  Neck  swelling  at  base  of  neck,  transilluminates  in  infant:  cystic  hygroma    16-­‐  Neck  swelling  moves  sideways  but  not  up  and  down:  ?carotid  body  tumor    17-­‐  A  boy  with  septic  arthritis  in  paper  1    18-­‐  Theme  in  paper  2,  (I  think  it  was  first  question  on  paper)  one  of  them  had  avascular  necrosis  and  other  had  SUFE?    Organism  causing  tonsillitis:  S.  Pneumoniae    Organism  causing  sinusitis  (facial  pain  and  post  nasal  drip)  :  S  Pneumoniae    Patient  with  lymphedema  and  infection:  what  organism?    Perianal  abscess  organism?  E  coli    Breast  abscess  organism?  Staph    Organism  causing  infection  with  dead  tissue  and  cripitus:  C  perfringens    Gangrene  of  hallux  (3  themes)  can’t  remember  them    Management  of  ulcer  ...  one  with  bed  sores  of  the  heel:  conservative  or  is  it  debridement  (can  anyone  remember  the  other  2?)    Parasitic  infestations,  one  patient  with  ova  at  anal  verge:  mebendazole  ...  another  patient  with  ova  and  cysts  in  faeces:  metronidazole    Determinant  of  cranial  blood  flow  in  a  patient  with  low  GCS:  ?intracranial  pressure    First  response  to  hge:  ?baroreceptors    First  substance  that  would  directly  cause  vasoconstriction:  Ag  II  (some  of  my  colleagues  say  that  rennin  causes  VC?)