April 2018 IMRCS A | Dr S.M.

Edited
Thanks to R.H. et al for the questions

APRIL MRCS A 2018 _ RECALL

1. Posterolateral hernia in child…..reason?

a. Failure of closure of right pleuroperitoneal membrane
b. Failure of closure of left pleuroperitoneal membrane
c. Failure of closure of septum transversum
d. Failure of closure of contribuiton fromnthe thoracic cavity wall

2. A statistician wanted to compare some parameter which was not distributed normally (the q mentioned few
patients had extremes of values) between two groups
a. Chi square
b. Mann whitney U
c. Paired T test
d. Unpaired T test
e. Kruksal wallis
3. 2 cm mass in lung in a smoker, another 1 cm mass in liver suspected to be hemangioma. No systemic signs
best investigation NEXT?
a. MRI liver
b. MRI whole body
c. CT chest
d. FDG PET CT
e. USG

4. Loss of weight, cough, tiredness, Multiple lymphadenopathy, Lateral aspect of tongue hairlike lesions
a. Lichen planus
b. Candidiasis
c. AIDS

5. Nerve injury, deltoid affection, which other muscle will be affecting ..teres minor
6. Fat overweight child, pain hip, external rotation on attempting to flex … Slipped femoral epiphyses
7. 6yo child pain hip in all range of motions, systematically well, no fever Perthes
8. Trauma to knee, swelling, excess lateral anguity on stress testing, injury to… MCL
9. Injury to knee and swelling, on 90 degrees tibia is more posterior than other side… PCL injury
10. 3 patients in surgical ward with Cl. Difficile, mode of transmission…
a. Endogenous
b. feco-oral
c. nosocomial
d. respiratory
e.
11. Test for rupture tendon achilles… Simmonds squeeze test
12. Sinus tarsi between bones?
a. … between talus and calcaneus
b. Talus and navi
c. Calc and navi
13. Lift thumb with hand 90 degrees on table (retropulsion test) … EPL
14. Mobile extensive femoral thrombus management initial management
a. Heparin,
b. Venous exploration,
c. Aspirin,
d. Embolectomy

Dr S.M. Edited
 April 2018 IMRCS A | Dr S.M. Edited
Thanks to R.H. et al for the questions

15. Which hormone decreases in warm condition…

a. TSH,
b. ACTH,
c. Vasopressin
16. Cleft palate embryology defect in fusion of what structures? … palatal processes
17. Result of failure to develop caudal portion of metanephros………….Kidney

18. Testicular cancer with normal AFP and HCG

a. Seminoma
b. Teratoma
c.
19. Relation of median nerve with respect to brachial artery in proximal arm… lat to ant to medial
20. Relation of ulnar nerve to ulnar artery… ulnar to the ulnar artery
21. Lesion in Dorsal root ganglion in neck, what type of loss?
a. Sensory
b. Motor
c. Sympathetic
d. Parasympathetic
e. All of the above
22. Atrophy thenar eminence… median nerve
23. Dermatome of the little finger… C8
24. Injury to esophagus during upper GI scopy ?
a. TPN
b. Nasoenteral feed
c. PEG
d. Elemental diet
25. Ix for rupture esophagus after endoscopy…
a. water soluble contrast
b. barium
c. upper GI scopy
d. Endo USG
e. Chest xray
26. Crohns …operated… resection of distal ileum and many stricturoplasties?...what nutrition??
a. Elemental diet
b. High nutrition oral or enteral diet
c. TPN
d.
27. Reciprocal of absolute risk reduction …NNT
28. Cushing reflex/triad… ↑BP ↓HR ↓RR
29. Athlete sudden death after marathon
a. SAH
b. IVH
c. EDH
d. SDH
e. Raised ICP
30. 6yo, kid with groin swelling, observed when the kid is playing around, which spontaneously reduces on lying
a. patent processus vaginalis
b. direct hernia
c. femoral hernia
d. indirect hernia
e. tortion testes

Dr S.M. Edited
 April 2018 IMRCS A | Dr S.M. Edited
Thanks to R.H. et al for the questions

31. Child with pain in the right scrotum with redness and irreducible groin mass
a. direct hernia
b. femoral hernia
c. indirect hernia
d. tortion testes
e.

32. Intrinsic pathway…factor IX

33. Old woman displaced # distal radius, reduced and put in slab/POP for 6 weeks, complaining of pain and limited
ROM in both supination and pronation after 3 months…
a. CRPS
b. Malunion
c. Nonunion
d.
34. Cervical lymph node, FNAC squamous cell ca, upper tract scopy was found to be normal. What investigation next
?
a. CT Neck
b. MRI neck
c. FDG PET CT
d. MRI whole body
e. ??
35. Diarrhea, pruritus ani, cellotape examination shows egg in stools…
a. Mebendazole
b. Metronidazole

36. Some q on clinica scenario of hypercholesterolaemia….

a. Hypothyroidism decreases cholesterol
b. Hypothyroidism increases cholesterol
c. ??

37. Advantage of carbohydrate rich drink in enhanced recovery program?

a. decrease post-operative insulin resistance and negative nitrogen balance
b. better abdominal muscle function
c. better respiratory muscle function
d. shorter hospital stay
e.
38. What’s in direct contact with T5 body…
a. azygos,
b. left atrium,
c. aortic arch OR its junction with ascending aorta
d.
39. Shoulder pain between 60-120 degrees… supraspinatus tendinitis
40. Gun shot to on right side below costal margin, injury to...
a. pylorus,
b. gallbladder
c.
41. Some trauma, led to UMN lesion of leg muscles. Where can be the lesion?
a. L1-2,
b. T12-L1
c. L2-L3
d. L3-L4

Dr S.M. Edited
 April 2018 IMRCS A | Dr S.M. Edited
Thanks to R.H. et al for the questions

42. Chinese man with LN enlargement and headache and deafness nasopharyngeal carcinoma
43. Spastic unilateral leg paraplegia which artery
a. ACA
b. MCA
c. PCA
d. Ant choroidal art
44. Impotence and vascular insufficiency, clue to Leriche syndrome occlusion to both common iliacs
45. Femoral canal lateral border… femoral vein
46. Diagnosis of DVT by… compression US
47. Patient with Barret’s esophagus… adenocarcinoma
48. Golfer with 1st Carpometacarpal joint pain, XR showed narrowed joint space and subchondral cysts… OA
49. Gangrene of the anterior abdominal wall…Cl. perfringens
50. Post-partum lady dies after 3 days causative organism… (???)
51. Osteomyelitis causative organism… Staph aureus
52. Brown sequard $... ipsi motor and proprioception + contra pain and temp
53. Hypercalcemia in a metastatic scenario, Ca 3.7 mmol/L, ECG abnormalities, “Initial” treatment…
a. IV 0.9% sodium chloride
b. Steroids
c. Pamidronate
d. Cinacalcet
e.
54. Hypothermia ECG change… J wave
55. 1cm melanoma over the back, best management…
a. excision biopsy with 2mm margin,
b. excision biopsy with 2cm margin
c. core biopsy
d.
56. 23-25 yr old female, single mobile breast mass, most appropriate investigation
a. USG
b. Mammo
c.
57. Site of action of fursemide… ascending loop of Henle
58. Site of action of thiazide… DCT
59. Male gynecomastia which drug… spironolactone
60. Posterior duodenal ulcer collapse, which artery… gastroduodenal
61. Site of Dartos muscle subcutaneous
62. Waddling gait, injury to… superior gluteal nerve
63. Bypass with graft, later is blocked… neo intimal hyperplasia
64. COPD patient… ↑CO2 ↑HCO3
65. Anterior relation to right adrenal…IVC
66. Good prognosis for melanoma…
a. Breslow thickness of 0.6
b. Clarks level 5
c. Lymphatic invasion
d. Satellite nodules
e. Ulceration

67. 62% burn patient presents with lower leg edema after 3 days…(pain was not mentioned in the q)
a. Hypoalbuminemia
b. DVT
c.

Dr S.M. Edited
 April 2018 IMRCS A | Dr S.M. Edited
Thanks to R.H. et al for the questions

68. Picture of x-ray with arrow I think was pointing at a structure at C3 level
a. hyoid bone
b. cricoid
c. thyroid
d. epiglottis
69. Male with pain in testes and urethral discharge…
a. Gonorrhea
b. Chlamydia
c.
70. Blood supply to transverse colon… middle colic artery
71. CPP calculation…BP was 125/80, ICP was 20….75
72. Submandibular duct excision injury to… lingual nerve
73. Post parotidectomy patient received radiation treatment, followed by presentation with dryness of eyes, which
ganglion involved…
a. Pterygopalatine
b. Otic
c. Ciliary
d. submandibular
74. Injury to head, fixed dilated pupil, cause…
a. unopposed sympathetic fibers
b. unopposed parasym
c. overaction of parasym
75. Osteoporotic crush to vertebra, serum calcium is likely to be…
a. Hypercalcaemia
b. Hypocalcaemia
c. Normocalcemia
76. Some clinical scenario, hypercalcaemia, given steroids, resolved………sarcoidosis
77. HPE in rheumatoid arthritis??????
a. Necrobiotic granuloma
b. Foreign body giant cell with lymphocytes
c. Macrophages
d. Eosinophilic granuloma
78. Fall in blood BP, 1st reaction…
a. sympathetic system
b. RAAS
c.
79. 11yo child with special need, going for laparoscopy, type of consent… (consent parents)
80. Ligation of splenic hilum, avoid injury “during the surgery” to what…
a. tail of pancreas
b. greater curvature
81. Ureter stone radiating to groin, which nerve root… (T11-L1)
82. What structure is in front of uncinate process… SMA
83. What forms the anterior surface of the heart
a. Mostly Rt atrium and ventricle
b. Mostly left ventricle
c.
84. Pigmentation,,,, clinical picture like addisons, electrolytes Na 128, K 5.8 or 6.8, which hormone to check (ACTH)
85. Some scenario with single site metastatic bone pain treatment…
a. radiotherapy, ??
b. NSAIDs
c. PCM
d. steroid

Dr S.M. Edited
 April 2018 IMRCS A | Dr S.M. Edited
Thanks to R.H. et al for the questions

86. Ovarian mass and inner thigh numbness, which nerve… obturator
87. Bilateral cervical lymph node spread, which type of cancer…tongue
88. Skin lesion, pearly… BCC
89. Skin lesion, central keratinous something…keratoacanthoma
90. UK NICE guidelines on people who received transfusion
a. can’t donate in future until viral markers are negative
b. Can donate within 6 weeks
c. Can donate within 12 weeks
91. Anterior compartment syndrome affecting… 1st dorsal web space
92. Pathology of berry aneurysm in 45yo…
a. Atherosclerosis
b. Cystic medial necrosis
93. site of lumbar puncture…
a. at the level of iliac crest ??
b. at the level of transtubercular plane
c. at the level of posterior superior iliac spine
d. at the level of posterior inferior iliac spine
e. at the subcostal level ??

94. ulcer at the tip of penis

a. squamous cell ca
b. adeno
c. transitional cell ca
d.
95. Ix for pheochromocytoma… urinary VMA
96. post-op day 6 , operated after trauma, with continued bleeding PT 18 secs, APTT 60 secs, Fibrinogen 0.1 … (DIC)
97. a hypertensive taking Ramipril. Q was , constriction of efferent arteriole by:
a. angiotensin 1
b. renin
c. angiotensin 2
d. aldosterone
e. ANP

98. some guy with a knee swelling and sudden pain in legs after some 7 days which and scenario of Moses sign
although the name wasn’t there, with disappearance of knee swelling …DVT
99. caecal cancer, resected, patho gave diagnosis T4, what do u mean by that?
a. Involving surrounding abdominal musculature
b. Multiple lesions in the resected specimen
c. Muscle invasion
d. Lymphatic or vascular invasion
e.
100. post op patient with known Graves, P 120, BP 160, treatment after salvaging then acute phase
a. betablocker + iodide
b. betablocker + thioamides
c.
101. Best investigation of choice for parathyroid adenoma
a. Sestamibi scan
b. USG
c. CT
d. MRI
e.
102. Can’t remember, most likely risk factor for HCC… (alcohol)

Dr S.M. Edited
 April 2018 IMRCS A | Dr S.M. Edited
Thanks to R.H. et al for the questions

103. Some 40s male, nausea, vomiting, blurring of vision and headache, particularly in the morning with no focal
neuro signs
a. Raised ICT?
b. Frontal glioma?
c. EDH?
d. SDH?
e. SAH?
104. Clinical scenario of MM, HPE what to expect
a. Plasma cells
b. Macrophages
c. Lymphocytes
d. Eosinophils

105. Asian middle aged man, found to have cavitatory lesion at the apex of left lung, HPE expected … (TB)
106. Associated with epispadias……(extrophy of bladder)
107. Hypospadias…developmental anomaly of urogenital fold
108. Can’t remember, some question about diffuse lung infiltrates or ARDS, cause of clinical picture?
109. Complete expiration from complete inspiration….lung volume?
a. VC
b. TLC
c. FRC
d. ERV

110. 30 yr old man, presented with Mediastinal mass. FNAC shows glandular pattern, absence of neuroendocrine
markers, illdefined clumps of cells.
a. Adenocarcinoma ??
b. Thymoma ??
111. Some trauma or surgery on condyles of femur or tibia. Followed by loss of pulsations. Injury? .... (popliteal)
112. Patient with liver laceration, during ot clamp free margin of lesser omentum. Possible damage to?
a. CBD
113. Post cardiac transplant… what increases Cardiac output?
a. Increased atrial filling
b. Increased intrathoracic pressure
c. Increased intrapericardial pressure
d. Some option acting via autonomic nervous system
114. Injury to axilla, numbness lateral forearm, which muscle will be affected as well?
a. Brachialis
b. Brachioradialis
c. Flexor carpi radialis
d. Pronator teres
e.
115. Can’t remember, question about heart valve component options had
a. Dense fibrous tissue
b. hyaline cartilage
c. smooth muscle
d. ?
116. Ureter relations,
a. Gonadal veins Cross anteriorly
b. Common iliac divide anteriorly
c.
117. pain on walking down hill but not uphill… (spinal stenosis)
118. patient post burn, with hematemeses… (acute gastric dilatation)

Dr S.M. Edited
 April 2018 IMRCS A | Dr S.M. Edited
Thanks to R.H. et al for the questions

119. multiple bone pains, on exam, illdefined hard prostrate , PSA 300. Management?
a. TURP,
b. radical prostatectomy,
c. incision of prostrate
d. hormonal therapy
e. active surveillance
120. long standing venous ulcer, swabbed , found to have MRSA, no signs of infection given in the q
a. oral lincopeptides( Vanco or Teico)
b. other beta lactams
c. beta lactams
d. beta lactams
e. no antibiotics

121. effect of smokig on body

122. trauma patient, “properly resuscitated”, when log rolling , suddenly became hypoxic or decompensated
a. displacement of tracheal tube
b. spinal injury

123. history of carrying heavy weight with back pain….facet arthropathy

124. tooth extraction, bleeding stopped then, started after some time….Factor VIII
125. mass in breast of 25 yr lady, mobile, non tender, what inv ?
a. USG
b. Mammo

126. Lady underwent mastectomy. Split skin graft taken from thigh. What type?
a. Allograft
b. Isograft
c. Autograft
d. Meshed graft ???
e. Xenograft
127. Post op patient of zygomatic repositioning, ear discharge, deafness …#petrous part
128. Pharyngeal pouch, between which muscles?... Thyropharyngeus and cricopharyngeus
129. 16 years old boy with gynaecomastia …..physiological)
130. Renal mass noted in USG. Next investigation?
a. CT
b. MRI
c. FNAC
d. PET?
131. Vessel originating above piriformis….sup gluteal
132. Trendelenberg test +ve……. gluteus medius
133. Post op patient deteriorating picture, P 60-70, BP 80/50, CVP 20
a. Heart block
b. Sepsis
c. Cardiac failure
134. Acute abdomen, amylase 110 [normal below 100], Ca 2.4 [2.1 – 2.8], LFT normal picture,
a. Acute intermittent porphyria
b. Perforation
c. Pancreatitis
d. Rest of the options I don’t remember , but nothing matching the q
e.

Dr S.M. Edited
 April 2018 IMRCS A | Dr S.M. Edited
Thanks to R.H. et al for the questions

135. Type 1 Diabetic patient on long term NSAID for osteoarthritis or some painful condition, post op creat high,
urea high
a. Reduced renal perfusion
b. Diabetic nephropathy
c. NSAID induced renal injury
d.
136. Etiopathogenesis of AAA……..atherosclerosis
137. Patient known case of iliac or femoral atherosclerosis or aneurysm. Came with sudden onset pale pulseless
limb….embolism
138. Patient with known periph vasc ds, underwent fem-distal bypass 1 yr back, now came with painful limb, DPA
not palpable, but doppler showing monophasic flow until ends…. DVT
139. Mass in breast, with eczema of nipple areola. Q was , apart from mammo what else will u do?
a. Exfoliative cytology
b. FNAC
c. Biopsy
d. MRI
140. Which of the following is true about Rt coronary artery?
a. Originates posteriorly from aorta
b. ………………anteriorly…………………
c. Originates from aortic sinus below the aortic valves
d. Present in posterior IV groove
141. Angle of loiu…junction of arch and descending
142. Another q Structure at/attached to T5..
a. Left atrium
b. Tracheal bifurcation
c. Bifurcation of pulmonary trunk
d. Bifurcation of right bronchus
e.

143. Some surgery led to injury to thoracic duct, surgeon wants to ligate it from thoracic approach. Where to find
a. Behind ascending aorta
b. Venecaval opening
c. Esophageal opening
d. Aortic hiatus
144. Post appendectomy, pus collection in…..
a. rectouterine pouch
b. vesicouterine ”
c. behind the rectum
d. in front of bladder
145. Scrotum… (superficial inguinal)
146. Ovary… (para aortic)
147. Below anal verge (superficial inguinal)
148. Middle aged man, testicular mass, HPE shows cells separated by fibrous septa containing lymphocytes…
a. Classical seminoma
b. Spermatocytic seminoma
149. Surface marking of IJV
a. styloid process to medial end of clavicle
b. ear lobule to medial end of clavicle
c. mastoid process to medial end of clavicle
d. lesser cornu of hyoid to medial end of clavicle
150. myasthenia……antibodies to acetylcholine
151. NSAIDS causing ulcer…by what mechanism … Cyclooxygenase

Dr S.M. Edited
 April 2018 IMRCS A | Dr S.M. Edited
Thanks to R.H. et al for the questions

152. Mechanism of peptic ulcer

a. Mucous cells
b. Chief cells
c. Oxyntic cells
153. Gunshot which entered at the junction of right rectus and right costal cartilage and exits exactly from the
opposite. Structure most likely injured ?
a. GB
b. Renal hilum
c. Pylorus
154. Some surgery on leg done under spinal with anaesthesia upto umbilicus…..T10
155. Patient with 9th 10th 11th and 12th cranial nerve lesion… medulla
156. Cause of metabolic alkalosis?
a. Nasogastric aspiration
b. Alcohol
157. Post op gustatory sweating….. parasym fibres developing into sweat glands
158. Some scenario and inj ampicillin or amoxicillin given; soon presented with scenario of anaphy rxn. Mediator?
a. Mast cells
b. Eosinophils
c. Lymphocytes
d. Macrophages

Dr S.M. Edited
 April 2018 IMRCS A | Dr S.M. Edited
Thanks to R.H. et al for the questions

EMQ Bladder
159. Egyptian, hematuria… SCC
160. Female long history of indwelling catheter and multiple recurrent infections, presents hematuria…SCC
161. Male in dye industry I think…TCC

EMQ on Ear
162. Discharge from ear for a 10 years, with middle ear perf and facial nerve palsy…cholesteatoma
163. … ()
164. … ()
165. Some kind of mass in neck? Don’t rememebr ……….Otitis media with effusion

Stupid EMQ on Jaundice

166. Man with pain, jaundice, fever….had similar episodes of pain abdo previously….choledocholithiasis
(cholangitis was not in options)
167. 30 yrs follow up patient of FAP operated for colon, now presented with OJ… Carcinoma of duodenum
168. … ()
169. … ()

EMQ Fluid burn calculation in 24h

170. 36% burn in some 60 or 70 kg
171. 19 yr old with 90 kg weight with burn of a leg and perineum

EMQ chest trauma

i. Chest drain
ii. Chest drain with suction
iii. CT
iv. Echo
v. Thoracotomy
172. Stab to right 4th ICS, normal CXR, tachy, rest normal
173. Stab to the left 5th ICS, tachy, rest normal
174. Stab to 5th ICS post axillary line, CXR showing pneumothorax with fluid level

EMQ Chest pain in pregnancy

175. 36 weeks, 28 yr, c/o Chest tightness and dyspnea. On exam, cyanosis and one more alarming feature. Dad
died of AMI at 62 yrs…..AMI
176. 36 weeks, 28 yrs, father died of AMI at 42 yrs, chest pain, no other info. Exceptionally(word used was some
different) tall….. Aortic Dissection
177. 36 weeks, 28 yrs, Preg lady with pleuritic chest pain followed by dyspnoea, father died at 60…. PE

EMQ Child gastrointestinal disorders

178. 6 months, sausage shaped mass…intussusception
179. 6 weeks non bile stained vomit after feeds…pyloric stenosis
180. Tender distended abdomen, per rectal bleed in 6 weeks baby……midgut volvulus
181. …

EMQ GCS
182. E2V2M2
183. E1V1M1

EMQ Ortho patterns of fracture

184. Twisting force… spiral

185. Child fracture with bowing happening after injury greenstick
186. Direct blow to femur… transverse

Dr S.M. Edited
 April 2018 IMRCS A | Dr S.M. Edited
Thanks to R.H. et al for the questions

187. Fracture humerus with metastatic lesion, mechanism was fracture happened while she was trying to aboard
a bus and got pulled by the running bus oblique

EMQ Ortho nerve injury

188. Posterior approach to femur… (tibial? common peroneal? posterior cutaneous nv of thigh?) (sciatic was not
in option)
189. Humerus posterior approach… radial
190. Medial approach to ankle… saphenous nerve

EMQ urethral injury

191. Pelvic fracture, unstable patient, DRE prostate unusual location… rupture membranous urethra
192. Fall with legs wide open on handle bar bulbar urethra injury

EMQ plastic
i. Full thickness graft
ii. Partial thickness graft
iii. Pedicled flap
iv. Microvascular free flap
v. Advancement flap
vi. Wound excision and primary closure
vii. Wound excision and 2nd ry closure
viii.
193. Dog bit off nose…
194. Cut wound scalp with dirt…
195. Garden fork in toe, 1cm dusky wound

EMQ Thyroid
196. 1 cm MCT … total thyroidectomy
197. 0.5 cm nodule found in one lobe of thyroid while operating for another surgery probably parathyroid…
hemithyroidectomy

EMQ Types of biopsy

198. Venous ulcer…incision biopsy

EMQ on Splenomegaly
199. Caucasian man, antibodies to EBV +... (Infectious Mononucleosis)
200.

EMQ on Acid Base

Dr S.M. Edited