2020

Recalls

January 2020 MRCS I.V.

 MRCS I.V. Course

Jan 2020
1. A man developed parathesia over the lateral aspect of his left thigh elicited by taping on the inguinal
ligament. What is the root of the causative nerve?
A. L1
B. L2-3 Lat cutaneous nerve
C. L3-4 Meralgia parasthesia
D. L1-3
E. None of the above

2. A 53 years old female developed pain, stitches in her hands especially at night. Her mother had
history of autoimmune disease. What will be the expected histological finding of this condition?
A. Rhomboid crystals
B. Needle-shaped crystals
C. Necrobiotic granuloma Dx: Rheumatiod arthritis
D. Sulfur granules
E. None of the above

3. A 53 years old patient developed back pain. Her bloods showed high phosphate, Ca and alkaline
phosphatase levels. What is the most likely cause?
A. 3ry hyperparathyroidism.
B. Metastatic cancer
C. Osteomalacia
D. Paget disease
E. 2ry hyperparathyroidism

4. A patient can't lift his thumb off the table with his palm facing upwards. Which is the most likely
responsible nerve lesion?
A. Anterior interosseous nerve
B. Median nerve
C. Posterior interosseous nerve.
D. Radial nerve
E. None of the above

5. Scaphoid bone receives its blood supply from:

A. Distal end
B. Proximal pole
C. Lateral end
D. Medial end
E. None of the above
6. A 12 years old boy suffered deep laceration of his right hand after falling on outstretched hands. On
examination, he is unable to perform thumb adduction. What is the most likely nerve lesion?
A. Superficial ulnar nerve
B. Anterior interosseous nerve
C. Deep ulnar nerve
D. Median nerve
E. Posterior interosseous nerve

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7. A 24 years old patient complained from recurrent loin to groin pain. Xray revealed multiple stones in
the kidney which were found to be made of calcium oxalate. What is the most likely cause?
A. Proteus infection
B. Urinary tract infection
C. Primary hyperoxaluria Most common : Hypercalciuria
Second most : Hyperoxaluria
D. Familial stones
E. None of the above

8. A patient was undergoing surgical release of Duptuyren's contracture at the ring finger while a nerve
was injured just lateral to the deep flexor tendons of ring finger. What is the nerve affected at this
site?
A. Superficial ulnar nerve
B. Deep ulnar nerve
C. Median nerve.
D. Radial nerve
E. Posterior interosseus nerve

9. A patient had lacerated his anterior aspect of the elbow joint. What is the most medial structure in
this site?
A. Median nerve
B. Anterior interosseus nerve
C. Radial nerve
D. Biceps tendon
E. Brachial artery

10. A 23 years old athlete has injured his ankle during a rugby game. Ankle X-ray was normal while ankle
pain persists. What is the most appropriate next step?
A. Ankle MRI By it we can see tendon or ligament injury
B. Repeat Xray
C. Ankle CT scan
D. Discharge and review
E. None of the above
11. A patient had an external tibial fixation for a complex tibial fracture. Now there is pus leaking from
the operative wound. What is the most likely causative organism?
A. E coli
B. Streptococcus pyrogens For external fixation : Staph aureus
For Implant : Staph epidermidis
C. Staphylococcus epidermidis
<10 days : Staph aureus
D. Staphylococcus aureus >10 days : Staph epidermidis (produces biofilm)
E. Streptococcus viridians

12. A 23 years old patient has noticed a cystic swelling in his popliteal fossa. What is the most lateral
structure in the popliteal fossa?
A. Common peroneal nerve
B. Popliteal artery
C. Popliteal vein
D. Tibial nerve
E. None of the above

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13. A patient was stabbed in his buttock during a fight. On examination he has a deep wound with loss of
plantar flexion of his foot and toes with normal dorsiflexion. What is the most likely injured
structure?
A. Common peroneal nerve
B. Pudendal nerve
C. Saphenous nerve
D. Tibial component of sciatic nerve
E. Sural nerve

14. A microbiologist contacts the urology consultant to report urinary tract infection affecting more than
one patient in the same ward. What is the most likely causative organism?
A. Pseudomonas
B. E.coli
C. Streptococcus pyrogens
D. Staphylococcus aureus
E. None of the above

15. A 59 years old female developed multiple frequent fractures with minimal trauma. What would you
expect in her laboratory investigations? Dx: Osteoporosis
Answer Ca Ph Alkaline phosphatase
A ↑ ↓ ↓
B ↓ ↓ ↑
C Normal Normal ↑
D ↑ ↑ ↑
E Normal Normal Normal

16. A 23 years old female had been diagnosed with a femoral hernia. During repair. What is the posterior
relation of hernial sac?
A. Inguinal ligament
B. Lacunar ligament
C. Pectineal ligament
D. Fascia transversalis
E. Femoral vein

17. A 2 days newborn was found to have a spinal cord anomaly. There is a sac protruding from his back
containing CSF only. What is the most likely diagnosis?
A. Spina bifida occulta
B. Meningomyelocele
C. Meningocele
D. Spinal canal stenosis
E. None of the above

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18. A urologist notices an evident slit on the dorsal surface of the penis in a 1-day newborn baby. This
anomaly is often associated with which of the following conditions?
A. Horseshoe kidney
B. Renal agenesis
C. Bladder exstrophy Epispadius+ exostrophy+Diaphragmatic hernia+ Intestinal malrotation
D. Polycystic kidney Hypospadius + Cryptorichidism
E. Bladder diverticulum

19. A female developed recurrent loin to groin pain for which she had Xray done revealing a radio
dense ureteric stone. What is the most likely composition of this stone?
A. Calcium oxalate
B. Calcium phosphate
C. Struvite
D. Cysteine
E. Uric acid stone

20. A 63 years old female was diagnosed with metastatic breast cancer. She suffered an injury to her
humerus while catching out for the bus. What is the expected type of fracture?
A. Transverse fracture
B. Oblique fracture
C. Green stick fracture
D. Spiral fracture
E. Buckle fracture

21. A 26 years old sexually active man has developed painful inflammatory swelling of his testis. He was
diagnosed with epididymoorchitis. What is the most likely causative organism?
A. Gonorrhea
B. Chlamydia
C. E coli
D. Pseudomonas
E. Treponema pallidum
22. A 23 years old athlete had his tibia fractured which was managed with an above knee cast.
Subsequently, he developed severe pain, so the cast was removed. The skin under the cast was
shiny, tense and pale. What is the most likely diagnosis?
A. Compartmental syndrome
B. Complex regional pain syndrome
C. Hypovolemic shock
D. Cellulitis
E. None of the above
23. A 42 years old typist presented with night painful stitches in her left hand with dropping objects
from her grip. What is the most appropriate definitive treatment for this condition?
A. Flexor retinaculum release
B. Steroid therapy
C. Physiotherapy
D. Analgesia with splint
E. None of the above

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24. A 12 years old child presented with left thigh pain and fever. Xray revealed a mass raising the
periosteum of his femur shaft. What is the most likely cause?
A. Osteosarcoma
B. Paget disease
C. Ewing sarcoma
D. Giant cell tumor
E. Multiple myeloma

25. A 4 years old child was found to have abnormal gait, shortening of his left leg with abnormal skin
crease on his left hip. What is the most likely diagnosis?
A. Perth’s disease
B. Developmental dysplasia of the hip
C. Slipped upper femoral epiphysis
D. Osteoarthritis
E. Osteogenesis imperfecta

26. A 12-year-old girl presented with pain in the left knee. On trials of flexion of the hip, external
rotation is noticed. What is the most likely diagnosis?
A. Perth’s disease
B. Developmental dysplasia of the hip
C. Slipped upper femoral epiphysis
D. Osteoarthritis
E. Osteogenesis imperfecta

27. A 70 years old man recently had been to Bangladesh and now presented with bloody diarrhea with
crampy abdominal pain. What is the most likely causative organism?
A. Salmonella typhi
B. Entamoeba histolytica
C. Campylobacter
D. E coli
E. Staphylococcus aureus

28. A 12-year-old boy fell on his hand while playing in the garden resulting in minimal deformity. What
is the expected type of fracture?
A. Greenstick fracture
B. Oblique fracture
C. Transverse fracture
D. Spiral fracture
E. Buckle fracture
29. A 25 years old lady presented with spontaneous hemarthrosis of her left knee. Her lab investigation
showed normal PT with high APTT. What is the most likely cause?
A. Stress fracture
B. Compartmental syndrome
C. Factor VIII deficiency Dx: Hemopholia
D. Sudeck’s atrophy
E. None of the above

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30. A 67 years old man presented with bilateral pelvic pain. On ultrasound there is bilateral
hydronephrosis with back pressure. He reported no history of trauma or UTI. What is the most likely
cause of this condition?
A. Ureteric stone
B. Bladder diverticulum
C. Urethral injury
D. Transitional cell carcinoma of the bladder
E. Bladder exstrophy

31. A 29 years old tennis player suffered a knee injury during practice. On examination, his left tibia is
noted to be posterior to the femur. What is the most likely cause of this condition?
A. Anterior cruciate ligament injury
B. Meniscal tear
C. Posterior cruciate ligament injury
D. Chondromalacia patella
E. Medial collateral ligament injury

32. A young footballer suffered a knee injury during pacing in a match. Several hours later he developed
swelling and pain in his left knee. Attempts to extend the knee were unsuccessful. MRI of the knee
would likely reveal:
A. Anterior cruciate ligament injury
B. Meniscal tear
C. Posterior cruciate ligament injury
D. Loose body
E. Medial collateral ligament injury

33. A footballer suffered knee injury during a match. Anterior drawer test was positive. Negative
McMurray test. What is the most likely cause of this condition?
A. Anterior cruciate ligament injury
B. Meniscal tear
C. Posterior cruciate ligament injury
D. Loose body
E. Medial collateral ligament injury

34. A 53 years old man presented with difficulty in hip abduction with evident waddling gait during
walking. Affection of which structure would produce this clinical picture?
A. Gluteus maximus muscle
B. Inferior gluteal nerve
C. Superior gluteal artery
D. Superior gluteal nerve
E. Sciatic nerve

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35. An 11 years old female child presented with bloody diarrhea and ova and cysts in the stools. What is
the most appropriate line of treatment?
A. Metronidazole
B. Mebendazole Causative organism : Entamoeba histolytica
C. Tinidazole
D. Bithionol
E. None of the above

36. A patient has developed loss of sensation over his left knee and medial aspect of the leg. Which
nerve root would be affected?
A. L1-2
B. L2-3
C. L3-4
D. L5-S1
E. None of the above
37. A 52 years old female developed a painful lesion affecting her left foot between 3rd and 4th toes
bases. She reports no history of trauma. What process best describes the cause of this lesion?
A. Inflammation and fibrosis of nerve
B. Compression ischemia of the nerve
C. Fibrosis of the perineural tissue Dx: Mortons Neuroma
D. Stress fracture of metatarsal bones
E. None of the above

38. A patient suffered ulnar nerve injury during a fight. On examination, marked clawing of his 4th and
5th fingers was observed. Where would you expect the lesion to be located?
A. At the axilla
B. At the wrist
C. At the elbow
D. At the mid-arm
E. None of the above

39. A 56 years old patient in on medical treatment for SLE. She reported multiple fractures with minimal
trauma. Her investigations confirmed a diagnosis of osteoporosis. Which of the following drugs is the
most likely underlying cause?
A. Azathioprine
B. Methotrexate
C. Corticosteroids
D. Hydroxychloroquine
E. None of the above
40. A patient has flushing, diarrhea with manifestations of paraneoplastic syndrome associated with
SIADH. Which of the following would be the most likely cause of this?
A. Adenocarcinoma of the lung
B. Squamous cell carcinoma of the lung
C. Hepatocellular carcinoma
D. Small cell lung cancer
E. None of the above

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41. A patient suffered head injury during a car accident. He was brought to ER with GCS of 14. He was
transferred for a CT brain when his GCS suddenly fell to 7. what is the next step?
A. Endotracheal intubation
B. Perform CT brain urgently within 1 hour
C. Call neurosurgeon
D. 3 view cervical Xray
E. Intracerebral monitor

42. A 45 years old woman developed a thyroid swelling. Her blood investigations showed normal thyroid
profile with CD20 cells and empty pale nuclei with atypical lymphocytic cells. What is the cause?
A. Papillary thyroid carcinoma
B. Hashimoto thyroiditis
C. Lymphoma
D. Follicular thyroid carcinoma
E. None of the above

43. A 40 years old patient has pneumonia not responding to antibiotics after 4 months from renal
transplant operation. What is the cause of this condition?
A. EBV
B. CMV
C. Pneumococci
D. Aspergilla's
E. Pseudomonas bacteria

44. A 50 years old non-smoker patient presented to your clinic with chest pain, hemoptysis and cough.
His investigations revealed a lung mass. What is the most probably cause of this condition?
A. Small lung cancer
B. Squamous cell carcinoma of the lung
C. Adenocarcinoma of the lung
D. Hamartoma in the lung
E. Lung lymphoma

45. A 60-year-old patient presented with a parotid swelling with facial nerve involvement. What is the
most likely cause of this condition?
A. Adenoid cystic carcinoma
B. Adenocarcinoma
C. Pleomorphic adenoma
D. Sarcoidosis
E. Mucoepidermoid carcinoma
46. A 22-year-old patient admitted to your hospital after RTA. His brain C.T shows cerebral edema. What
is the best management of this condition?
A. Administration of mannitol If tumour then dexa
if head inj mannitol it is
B. Give patient dexamethasone
C. Hypotonic solution administration
D. Give patient normal saline
E. None of the above

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47. A 35 years old man was stabbed in his chest, presented with difficulty breathing and tracheal shift.
On auscultation of his chest, air entry was diminished on the left side. What is the diagnosis?
A. Hemothorax
B. Flail chest
C. Cardiac tamponade
D. Tension pneumothorax
E. Aortic disruption
48. A 35-year-old female came to your breast clinic with pain in her beast. She was very worried as she
has positive family history of cancer breast. She also reported greenish discharge upon squeezing
her nipple. What is the cause of this condition?
A. Mammary duct ectasia
B. Intra ductal papilloma
C. Periductal mastitis
D. Beast abscess
E. Invasive duct carcinoma

49. An 66-year-old lady with breast cancer has undergone mastectomy. 5/14 LNs were positive, but she
is ER and PR-ve and Herceptin positive. What do you give for her?
A. Radiotherapy
B. Herceptin ALONE Herceptin only: HER +
Herceptin + ECF: her positive plus lymph node
C. Herceptin and chemotherapy Tamoxifen: ER+PR positive
Radiotherapy: after Wide local and invasive, high grade mastectomy
D. Tamoxifen
E. Letrozole Chemotherapy: Grade 3, and downstage of tumor

50. A 63 years old man had undergone liver transplant. On staining of the resected liver, it turned blue.
What is the underlying pathology?
A. Hemochromatosis
B. Cirrhosis
C. Hepatocellular carcinoma
D. Wilson disease
E. Amyloidosis

51. A 53 years old patient with Myasthenia Gravis is now presented by dyspnea and hemoptysis. CT
chest revealed a mass in the mediastinum. what do you think it is?
A. Small cell lung cancer
B. Squamous cell lung cancer
C. Thymoma Myasthenia Gravis = thymoma
Lambert Eaton myathenic syndrome = small cell lung cancer
D. Carcinoid tumor
E. Mesothelioma
52. A patient was brought to ER after suffering a car accident, He is able to say words, localize pain and
opens his eyes spontaneously. What is the corresponding GCS score?
A. 10
B. 9 E4
C. 12 V3
M5
D. 14
E. 13

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53. A patient developed homonymous hemianopia. Where is the lesion?

A. Optic radiation
B. Optic chiasma
C. Cerebral cortex
D. Pituitary gland
E. None of the above
.
54. A 51 years old patient had a surgery while still on aspirin and clopidogrel until the day before
surgery, now he has oozing from wound. What is the most likely cause?
A. De-arranged platelet function due to aspirin and clopidogrel.
B. Decreased extrinsic pathway of clotting factors
C. Decreased intrinsic pathway of clotting factors
D. Increase capillary fragility
E. None of the above

55. A patient undergone splenectomy after trauma. During operation the surgeon was due to ligate the
splenic artery. What is the structure most likely to be injured during this step?
A. Tail of pancreas
B. Fundus of stomach
C. Pancreatic duct
D. Phrenico-colic ligament
E. Small intestine

56. Which of the following parameters would be expected in a blood film after splenectomy?
A. High platelet count
B. High basophils Granulocyte
t (neutrophil) > Platelet > Reticulocyte
C. Neutrophilia o

D. Lymphocytosis a
d
E. None of the above d

n
57. A 65 years old patient undergone esophagectomy
o for esophageal cancer. What is the most
t
appropriate method of nutrition to be considered?
e
A. Feeding jejunostomy s

B. PEG tube insertion

C. Total parenteral nutrition
D. NG tube feeding
E. Enteral feeding

58. A patient has reduced tissue perfusion and hypoxia. Which of the following methods is not reliable
for detection of O2 saturation?
A. Arterial blood gases
B. Arterial capnogram
C. Pulse oximetry
D. All of the above
E. None of the above

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59. A 22-year-old lady has loss of sensation over the tip of the nose. Where else would she lose
sensation?
A. Soft palate.
B. Ear pinna
C. Cornea
D. Hard palate
E. All of the above

60. A man undergone long segment small bowel resection and anastomosis. Which feeding option
would you prefer to use?

A. Feeding jejunostomy
B. PEG tube insertion
C. Total parenteral nutrition
D. NG tube feeding
E. Enteral feeding

61. A 66 years old man with diabetes mellites for which he is taking metformin is going to have
herniotomy. Blood tests revealed lactic acidosis. What is the most likely cause?
A. Diabetic acidosis
B. Metformin.
C. Prolonged procedure.
D. Prolonged vomiting
E. None of the above

62. A patient developed severe hypothermia. Which is the best way for rewarming?
A. Double blankets
B. Theater temperature
C. Warm intraperitoneal fluids
D. Space blankets
E. None of the above

63. A 72 years old female suffered a radial fracture after falling on her hand. Which type of anesthesia
would be suitable in her case?
A. Bier's block
B. General anesthesia
C. Local anesthesia
D. Halothane mask
E. None of the above

64. Which anesthetic agent is used for Bier's block?

A. Prilocaine.
B. Bupivacaine
C. Lignocaine
D. Halothane
E. None of the above

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65. Which anesthetic agent is used for ring block?

A. Prilocaine.
B. Bupivacaine
C. Lignocaine alone
D. Lignocaine with adrenaline
E. None of the above

66. A 32 years old man with a crusty dry burn wound in the anterior abdominal wall. The best
management for his wound is:
A. Split thickness graft
B. Full thickness graft
C. Leave it uncovered
D. Compression bandage
E. Local flap

67. A patient undergone colectomy and anastomosis for a colon cancer. Postoperatively, she received 6L
of normal saline. Her ABG would probably show which of the following?
A. Hyperchloremic metabolic acidosis
B. Hyperkalemic metabolic acidosis
C. Hypochloremic metabolic acidosis
D. Normokalemic metabolic acidosis
E. None of the above

68. A patient undergone lap hernia repair. Postoperatively, urine output chat is hourly
As 80 ml / 80ml/ 80 ml /0ml/ 0ml/ 0ml in last 5 hours. What is the most likely cause?
A. Inadequate fluid therapy
B. Blocked catheter
C. Blood loss
D. Diabetes insipidus
E. None of the above

69. Which structure is responsible for descent of the testis into scrotum?
A. Spermatic cord
B. Tunica vaginalis
C. Tunica albuginea
D. Gubernaculum
E. Cremasteric muscle

70. Which of the following changes is expected after cholecystectomy?

A. Decreased secretion of bile salts
B. Reduced hepatic circulation of bile salts
C. Increased production of bile acids
D. Elevated bile salt secretion
E. None of the above

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71. Which of the following is correct regarding fresh frozen plasma?

A. It should be used Within 24 hours Platelets ass with Gram postive septcaemia
Packed RBC with Gram negative septcaemia
B. It is leuco-depleted
C. Cross matching must be done
D. Urticaria is not common complication of plasma transfusion
E. None of the above

72. During cholecystectomy, a patient develops extreme bradycardia. He has a history of cardiac
transplant. Which drug to give?
A. Atropine
B. Glycopyrrolate
C. Ephedrine
D. Isoproterenol
E. None of the above

73. During esophagectomy, the operating surgeon injured thoracic duct. Chyle will be collected in:
A. Middle mediastinum
B. Posterior mediastinum
C. Pericardium
D. Visceral pleura
E. Anterior mediastinum

74. A newborn was found to have cleft palate. What is the most likely embryological cause?
A. Non-fusion of palatine arches.
B. Non fusion of maxillary processes
C. Non fusion of medial nasal process with maxillary process
D. Non fusion of lateral nasal process with maxillary process
E. None of the above

75. A 62 years old man with a pearly lesion on his bald head, but he scratched it and now it ulcerated
and bleeding. what is your diagnosis?
A. Basal cell carcinoma
B. Squamous cell cancer
C. Melanoma
D. Keratoacanthoma
E. Seborrheic keratosis

76. A Patient has brain trauma due to RTA and increased intra cranial tension was observed. One
method has been used to lower ICP?
A. Increase PCO2
B. Decrease PCO2
C. Increase PO2
D. Decrease PO2
E. None of the above

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 MRCS I.V. Course

77. Pernicious anemia is an autoimmune disease caused by antibodies against what?

A. Ab against parietal cell
B. Ab against peptic cell
C. Ab against thyroid gland
D. Antiphospholipid antibodies
E. Anticardiolipin antibodies

78. During lumber puncture, what is the last layer to be pierced?

A. Dural sheath
B. Arachnoid
C. Pia matter
D. Anterior longitudinal ligament
E. Interspinous ligament

79. What is the posterior relation of inguinal hernia?

A. Transversalis fascia and conject tendon
B. External oblique aponeurosis
C. Internal oblique muscle
D. Rectus muscle
E. Posterior rectus sheath

80. What is most common nerve injury in posterior triangle?

A. Spinal accessory
B. Cranial accessory
C. Vagus nerve
D. Glossopharyngeal nerve
E. Lingual nerve

81. Which structure will not be damaged in tracheostomy?

A. Ascending pharyngeal artery
B. Thyroid isthmus
C. Recurrent laryngeal nerve
D. Anterior jugular vein
E. All of the above

82. What is the embryological origin of ductus arteriosus?

A. 2nd pharyngeal pouch
B. 3rd pharyngeal arch
C. 4th pharyngeal arch
D. 5th pharyngeal arch
E. 6th pharyngeal arch

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83. What is the origin of the muscles of facial expression?

A. 1st pharyngeal arch
B. 2nd pharyngeal arch
C. 3rd pharyngeal arch
D. 4th pharyngeal arch
E. 5th pharyngeal arch

84. An 8-year-old boy is brought by his mother with bright red rectal bleeding. On examination, there is
no remarkable finding except a noticeable lump coming from anus.
What is the most likely underlying diagnosis?
A. Juvenile polyp
B. Intussception
C. Anal fissure
D. Meckel diverticulum
E. Piles

85. Following birth, urachus is obliterated to form which of the following structures?
A. Medial umbilical ligament
B. Lateral umbilical ligament
C. Median umbilical ligament
D. Ligamentum teres
E. Ligamentum venosus

86. What is the effect of intermittent positive pressure ventilation (IPPV) on the CVS?
A. Reduce the preload Increase intrathoracic pressure so dec venous return preload dec
B. Increase preload
C. Reduce afterload
D. Increase afterload
E. Reduce stroke volume

87. A 53 years old man is prepared for an exploration surgery. Which layer is incised if the upper midline
incision was done?
A. Linea alba
B. Linea semilunaris
C. Fascia transversalis
D. External oblique muscle
E. Internal oblique muscle

88. Which of the following structures is opened during inguinal herniorrhaphy?

A. External oblique Aponeurosis
B. Internal oblique muscle
C. Conjoint tendon
D. Fascia transversalis
E. Peritoneum

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89. Which of the following muscles is working during quiet inspiration?

A. Diaphragm
B. Internal intercostal
C. External intercostal
D. Serratus anterior
E. Sternomastoid muscle

90. What is the Lymphatic drainage of ovaries?

A. External and internal iliac LN
B. Paraaortic L.N
C. Inguinal L.N
D. Obturator L.N
E. None of the above

91. What is the Lymphatic drainage of cervix of uterus?

A. External and internal iliac LN
B. Paraaortic L.N
C. Inguinal L.N
D. Obturator L.N
E. None of the above

92. What is the Lymphatic drainage of testis?

A. External and internal iliac LN
B. Paraaortic L.N
C. Inguinal L.N
D. Obturator L.N
E. None of the above

93. What is the Lymphatic drainage of prostate?

A. External iliac LN
B. Paraaortic L.N
C. Inguinal L.N
D. Obturator L.N
E. None of the above

94. A 53 years old male presented with an ulcer at the anal canal just below the dentate line.
Histopathology revealed a squamous cell carcinoma of the anal canal. To which group of LNs would
this lesion metastize?
A. Internal iliac L.N
B. External iliac L.N
C. Horizontal superficial ling LN
D. Vertical superficial inguinal L.N
E. Paraaortic L.N

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95. A child swallowed a coin and now presented with difficulty breathing. Xray showed the coin at the
gastro-esophageal junction. How far is this from the incisors?
A. 22 cm
B. 25 cm
C. 27 cm
D. 30 cm
E. 40 cm
96. Which structure is not in direct posterior relation to the 3rd part of duodenum?
A. Aorta
B. Right kidney
C. Right ureter
D. Right psoas
E. IVC

97. Which structure is posterior to the right lung hilum?

A. Vagus nerve
B. Phrenic nerve
C. Recurrent laryngeal nerve
D. Glossopharyngeal nerve
E. Accessory nerve

98. What is the blood supply to the transverse colon?

A. Middle colic artery
B. Left colic artery
C. Right colic artery
D. Ileocolic artery
E. All of the above
99. A patient suffered from atrophic gastritis and anemia. what kind of anemia would you find in her
blood film?
A. Macrocytic
B. Microcytic
C. Spherocytes
D. Normocytic
E. None of the above

100. A young man presented by right iliac fossa pain after central pain around umbilicus and
diagnosed as appendicitis, why did pain appear first in the central abdomen?
A. Because appendicitis is swollen, and it contacts both anterior and posterior abdominal
walls.
B. Because the pain is first conveyed by vagus parasympathetic fibers then somatic fibers in
the parietal protonium of the abdomen
C. Because the pain first conveyed by sympathetic fibers that enter the spinal cord at T10,
then by somatic fibers in the parietal peritoneum of the abdominal walls.
D. Because appendix first irritates the subcostal nerve then the ilioinguinal nerve
E. Because the most sensitive fibers is the afferent sympathetic fibers that enter the spinal
cord at T 10, then the less sensitive fibers from the lower quadrant abdomen

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101. Which drug is used in septic shock?

A. Epinephrine
B. Norepinephrine
C. Dopamine
D. Dobutamine
E. Isoprenaline

102. What is the spinal root of the external anal sphincter?

A. S2-3-4
B. L4-5
C. L5-S1
D. S1 alone
E. S3-4-5

103. A pregnant woman is duo to undergo episiotomy for labor. Which nerve is blocked?
A. Internal pudendal nerve block
B. Obturator nerve block
C. Ilioinguinal nerve block
D. Superior gluteal nerve block
E. Inferior gluteal nerve block

104. What is the surface marking of the internal jugular vein?

A. Lobule of the ear to the Sternoclavicular joint
B. Mastoid to the Sternoclavicular joint
C. Styloid process to the Sternoclavicular joint
D. Anterior Border of sternocleidomastoid
E. The angle of mandible to the middle 3rd of clavicle

105. A 71-year-old lady trips over and falls landing on her left shin. She sustains a large pretibial
laceration of her leg leaving a dirty wound with rugged flap edges. What is the appropriate wound
management?
A. Immediate split thickness skin graft
B. Delayed split thickness skin graft
C. Primary closure
D. Delayed primary closure
E. Randomized free flap

106. A confusing question about CPP without BP

A. 5%
B. 10%
CPP = MAP - (ICP + JVP)
C. 15%
D. 20%
E. 25%

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 MRCS I.V. Course

107. A 53 years old farmer presented with a groin mass. On examination, an abnormal growth was found
under the big toe nail with discoloration. What is the most likely diagnosis?
A. ВСС
B. SCC
C. Malignant melanoma
D. Lymphoma
E. Keratoacanthoma
108. A 52 years old lady that had lived in Australia a long time and recently returned to the UK presented
with a suspicious skin lesion. What is the underlying diagnosis?
A. ВСС
B. SCC
C. Malignant melanoma
D. pyogenic granuloma
E. Keratoacanthoma

109. A 52 years old man who is overweight, waking up at night with thirst, desire to micturate. His
random glucose level was 11.9. What is the underlying diagnosis?
A. Diabetes insipidus
B. Diabetes mellitus
C. Impaired fasting blood sugar
D. Sepsis
E. SIADH

110. A 62 years old smoker presented to ER with dyspnea. Pulmonary function revealed a high FEV/FVC
ratio. What is your diagnosis?
A. Obstructive lung disease
B. Restrictive lung disease
C. COPD
D. Asthma
E. Emphysema

111. A 52 years old smoker patient is due to undergoing an elective colon resection. What is the most
appropriate method of thromboprophylaxis?
A. LMWH and stockings
B. LMWH
C. IVC filter
D. Oral anticoagulant
E. None of the above

112. A 55 years old woman is on IV heparin for a recurrent pulmonary embolism. She is planned to have
an elective hysterectomy. What is the most appropriate method of thromboprophylaxis?
A. LMWH and stockings
B. LMWH
C. IVC filter
D. Oral anticoagulant
E. None of the above

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 MRCS I.V. Course

113. What is the level of iliac bifurcation from aorta?

A. T1
B. L12
C. L3
D. L4
E. L5

114. The external spermatic fascia is derived from which of the following structures?
A. External Oblique muscle
B. Internal oblique muscle
C. Transversus abdominus
D. Rectus muscle
E. Fascia transversalis

115. A patient complained that his right side of the face is dry with loss of ciliospinal reflex. Which
autonomic ganglia is responsible?
A. Ciliary ganglion
B. Gasserian ganglion Dx : Horners syndrome
C. Satellite ganglion
D. Pterygopalatine ganglion
E. Submandibular ganglion

116. Differentiation between UMNL and LMNL facial nerve palsy by which of the following?
A. Inability to raise eyebrow
B. Inability to squeeze eye or close it
C. Inability to blow the cheek
D. Inability to whistle
E. Inability to tense muscle neck

117. A 32 years old female who weighs 90 kg with circumferential burn to a lower limb and perineum
and how much fluid to give in 24hrs?
A. 2-3L
B. 3-4L 90x19x2 = 3420 ml

C. 4-5L
D. 5-6L
E. 7-9L

118. What is the Best prognostic factor in malignant melanoma?

A. Breslow thickness Breslow 0.6
B. Free margins
C. No lymph nodes involved
D. No distant spread
E. Clark classification

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119. Innervation of the costal part of the parietal pleura is via which of the following?
A. Intercostal nerves peripheral and mediastinal phrenic
B. Mediastinal intercostal nerves and phrenic peripheral
C. Vagus nerve
D. Phrenic nerve
E. Recurrent laryngeal nerve

120. A 54 years old man presented with low Na+ value and hypervolemia. What is the most likely
diagnosis?
A. Nephrogenic diabetes insipidus
B. Central diabetes insipidus
C. Diabetes mellites
D. SIADH
E. Conn's disease

121. A 34-year-old gardener presents with a lesion on the dorsum of his hand. It has been present for the
past 10 days and occurred after he hit his finger with a hammer. On examination he has a raised
ulcerated lesion which bleeds easily. What is the diagnosis?
A. Pyogenic granuloma
B. Keratoacanthoma
C. Dermatofibroma
D. Basal cell carcinoma
E. Squamous cell carcinoma

122. Which of the following is not considered a measure to enhance rapid recovery after a hip surgery?
A. A carbohydrate rich solution 2 hours preoperatively
B. Preoperative anti emetic
C. No nasogastric tube
D. Limit IV fluids
E. Mobilize early

123. Which of these symptoms and signs is specific for hypocalcemia?

A. Trousseau sign
B. Chvostek sign
C. Carpopedal spasm
D. Convulsion
E. All of the above

124. A 66-year-old man presented with BP 140/80. His HR was 80 beat/min. He was conscious,
orientated. After eye examination, there was nystagmus. His neurological examination showing
slurred speech, inability to walk on straight line. What is your diagnosis?
A. PICA syndrome
B. Anterior circulation occlusion
C. Lacunar syndrome
D. Partial anterior circulation occlusion
E. None of the above

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125. A 1-month child presented by non-bilious vomiting and he is diagnosed as pyloric stenosis. What
you will find in his ABG?
A. Hypochloremic metabolic alkalosis
B. Hyperchloremic metabolic alkalosis
C. Hypochloremic metabolic acidosis
D. Hyperchloremic metabolic acidosis
E. none of the above

126. At which of the following sites are mannitol and glucose normally absorbed in the kidney?
A. Proximal convoluted tubule
B. Distal convoluted tubules
C. Ascending loop of Henle
D. Descending loop of Henle
E. Collecting tubules

127. In a case of chronic pancreatitis, what is the first non-invasive test to be done?
A. Lipase
B. Amylase
C. Fecal elastase
D. Chymotrypsin
E. trypsin

128. A 63 years old man has a spinal metastasis from a colonic cancer. He is now dyspneic, tachycardic
with normal BP. where is the level of the lesion if it is not interfering with breathing?
A. Hyoid
B. Thyroid
C. Cricoid
D. At level of mandible
E. None of the above

129. A child has an irreducible scrotal swelling his mother noticed while giving him a bath. The swelling
transilluminates and is adherent to the testis. What is the most likely diagnosis?
A. Congenital irreducible hernia
B. Spermatocele
C. Torsion of testicular hydatid
D. Congenital hydrocele
E. Testicular tumor

130. A man is getting a human heart valve for Rheumatic heart disease. What kind of graft?
A. allograft
B. Autograft
C. Xenograft
D. Isograft
E. None of the above

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131. A 33 years old man developed persistent diarrhea and bleeding per rectum for 2 months. His uncle
died of a colon cancer at the age of 45. Colonoscopy revealed multiple sessile lesions affecting most
of the colon. What is the pathological change of theses lesions?
A. Dysplasia
B. Hyperplasia
C. Metaplasia
D. Hamartoma
E. Neoplasia

132. What is the appropriate initial treatment in hypercalcemia?

A. K supplementation
B. Diuretics
C. Mannitol
D. Normal saline
E. Pamidronate

133. A 53 years old man with portal hypertension suffered recurrent hematemesis. What is the source of
bleeding?
A. Right gastric vein
B. Left gastric vein
C. Gastroduodenal vein
D. Right gastroepiploic vein
E. Left gastroepiploic vein

134. What is the most common site of Mickle diverticulum?

A. Jejunum
B. Duodenum
C. Ileum
D. Ascending colon
E. Rectum

135. A 12 years old child with imperforate anus, congenital heart disease and cloudy vision. Which
vitamin is expected to be deficient?
A. Vitamin A retinol
B. Vitamin C ascorbic acid
C. Vitamin B
D. Vitamin E
E. Vitamin D

136. A 55 years old man is recovering from an elective hip surgery when he complained of dyspnea,
tachycardia and chest pain. His BP is 140/90 with no fever. What is the best initial investigation?
A. D dimer test
B. CT Pulmonary angiogram
Dx : Pulmonary Embolism
C. Chest Xray
D. Arterial blood gases
E. ECG

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137. A man was stabbed with a shrapnel in the buttock beside anus, what to do?
A. Primary closure
B. Delayed primary closure
C. Split thickness graft
D. Full thickness graft
E. Flap

138. An 8 months screaming child was brought by his mother who described that he passed a red jelly
stool this morning. What is the most likely underlying diagnosis?
A. Intussusception
B. Meckel diverticulum
C. Necrotizing enterocolitis
D. Juvenile polyp
E. Duodenal atresia

139. A preterm baby was brought 10 days after birth with bile from NG tube, abdominal distention and
bloody diarrhea. What is the most likely underlying diagnosis?
A. Intussusception
B. Meckel diverticulum
C. Necrotizing enterocolitis
D. Juvenile polyp
E. Duodenal atresia

140. Which nerve carries the sensory supply of the angle of the jaw?
A. Mandibular branch of trigeminal
B. Auriculotemporal
C. Marginal mandibular of facial
D. Inferior alveolar nerve
E. Great auricular nerve

141. A man suffers hoarseness of voice after a neck surgery. Of which of the following nerves does the
causative nerve emerge?
A. Vagus nerve
B. Glossopharyngeal nerve
C. Phrenic nerve
D. Accessory nerve
E. Lingual nerve

142. A 32 years old man undergone appendicectomy. Postoperatively, he is drowsy, BP 100/60,

tachycardic with low urine output. What is the best initial line of treatment?
A. Transfer to HDU
B. Re-exploration of operative site
C. Abdominal ultrasound
D. Challenge test with 250-500 ml ringer lactate
E. Transfer 2 units of packed RBCs

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143. A 65 years old man presented with bleeding per rectum for 2 days for which he was admitted
for colonoscopy which was unsuccessful because the patient was agitated during the procedure and
refuse to continue it. What is next appropriate investigation?
A. Repeat colonoscopy after preparation
B. PET scan
C. CT colonography
D. Abdominal ultrasound
E. None of the above

144. A patient was undergoing routine checkup when the radiologist reported an abdominal aortic
aneurysm of 4.7cm size. What is the most appropriate treatment plan?

A. Surveillance with US USS surveilance :

B. Open AAA repair 3 - 4.4 cm : Every year
4.5 - 5.4 cm : 3 monthly
C. Endovascular AAA repair
D. Endovascular embolization
E. None of the above

145. A 29 years old porter work as carrier for heavy boxes complained from prolonged history of
constipation and some felling of swelling at the end of defecation and he now presented to A&E
after carrying heavy box with a swelling protruding from anal region with perianal hematoma by
examination. What is the most likely underlying diagnosis?
A. Hemorrhoids
B. Rectal prolapse
C. Anal fissure
D. Anorectal cancer
E. None of the above

146. A 34 years old man presented with fever. He cannot tolerate the DRE because of severe pain
causing the sphincter to tighten. What is the most likely underlying diagnosis?
A. Hemorrhoids
B. Abscess
C. Anal fissure
D. Anorectal prolapse
E. None of the above

147. A 45 years old female with Crohn’s disease who undergone drainage for a perianal abscess is
now getting anal pain and occasional discharge. What is the diagnosis?
A. Diverticular disease
B. Recurrent perianal abscess
C. Perianal fistula
D. Anal fissure
E. Anorectal prolapse

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148. A 52 years old lady presented with a swelling in her groin that appears on standing. It is reducible
with an overlying thrill. What is the most likely underlying diagnosis?
A. Femoral aneurysm
B. Saphena varix
C. femoral hernia
D. Inguinal hernia
E. Hydrocele

149. A 65 years old man presented to ED with pain in his left thigh after walking for a specific distance.
His pulse is 88 and blood pressure 110/70 with intact distal pulsations on the other limb. What is the
expected site of stenosis?
A. Aorta
B. Common iliac artery
C. Internal iliac artery
D. Femoral artery
E. Superficial femoral artery

150. A 55 years old lady presented with weight loss and absolute constipation. Her examination was
unremarkable except for a distended tender abdomen with tachycardia. What is the most
appropriate investigation?
A. CT abdomen
B. Colonoscopy Suspected obstruction secondary to malignancy
C. Barium enema
D. Small bowel study
E. Proctoscopy

151. Which statement best describes a Duke's C colon cancer?

A. Involvement of regional lymph nodes A-mucosa
B. Direct local invasion of urinary bladder B-muscularis propria
C-local LN
C. Localised tumor to mucosa and submucosa D-distant mets
D. Free lymph node with invasion of musculosa
E. None of the above

152. A 9 years old child presented with a pelvic fracture after a fall. On examination, BP was 110/77,
pulse is 105 with a HB level of 8.4. You decide to transfuse a unit of packed RBCs, but his parents
refused for a religious reason. What is the best next step?
A. Go for blood transfusion without consent
B. Discharge the patient
C. Apply to the court
D. Obtain consent from the patient
E. Obtain consent from 2 expert doctors

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153. A 52 years old lady had been suffering from retrosternal pain for 3 years. She is now presented with
dysphagia to solids for which an upper GI endoscopy was performed and revealed a mass at the
lower third of the esophagus. What is the expected pathology?
A. Squamous cell carcinoma
B. Adenocarcinoma
C. Signet ring carcinoma GERD > Barrets esophagus > Adenocarcinoma
D. Adenoma
E. None of the above

154. Which method of sterilization is the best for endoscopy tools?

A. Dry oven,
B. Laser
C. Gas sterilization
D. autoclave
E. Formaldehyde

155. A 56 years old man had an ileostomy for an obstructing metastatic cancer colon. He notice bulge
neighboring to the stoma two weeks age and He is now presented with abdominal pain, vomiting.
The stoma was not discharging for the last 2 days. What is the most underlying diagnosis?
A. Recurrence of cancer colon
B. Prolapsed stoma
C. Incisional hernia at stoma site
D. Chronic constipation
E. Ischemic colitis

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Notes

Anatomy Recalls 28 MRCS I.V. Course