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Question and answers for MRCS preparation
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chapter1 QUESTIONS
Basic sciences: Applied anatomy
1. Which among the following statements regarding the functions of the
extraocular muscles is incorrect?
A. The inferior oblique muscle abducts the eye and moves it upwards
B. The superior rectus muscle abducts the eyes and moves it laterally
C. The superior oblique muscle abducts the eye and moves it downwards
D. The medial rectus muscle moves the eye medially
E. The inferior rectus muscle adducts the eye and moves it downwards
Basic sciences: Physiology
2. From the following statements regarding normal wound healing,
choose the one statement which is incorrect.
A. Wound healing can proceed in the absence of polymorphonuclear leucocytes
B. Monocytes are essential for wound healing
C. Collagen is formed by two polypeptide chains
D. Type IV collagen is predominantly seen in the basement membrane
E. The normal ratio of type I to type III collagen in the skin is approximately 4:1
Basic sciences: Pathology
3. Which among the following statements regarding metaplasia is
not true?
A. Metaplasia is the transformation of one fully differentiated cell type into another
B. Metaplasia may be reversible
C. Barrett’s oesophagus is a type of squamous metaplasia
D. Metaplasia can be a physiological process
E. Metaplasia characterized by abnormal mitosis, pleomorphism, and a high nuclear/
cytoplasmic ratio
01_Thrumurthy_Ch01.indd 1 11/5/2012 6:15:59 PM
, 2 QUESTIONS
Common surgical conditions and the subspecialties: Trauma
and orthopaedics
4. A 54-year-old woman presents with a 1-month history of a painful right
shoulder. The pain is present on almost all movements and movements
in the joint are restricted because of the pain. Both active and passive
movements result in pain. Plain radiographs of the shoulder are
normal. What is the most likely diagnosis?
A. Acute calcific tendonitis
B. Supraspinatus tendonitis
C. Adhesive capsulitis
D. Rotator cuff tear
E. Subacromial bursitis
Common surgical conditions and the subspecialties: General presenting
symptoms or syndromes
5. A 47-year-old alcoholic presents to the Emergency Department with
central abdominal pain and vomiting. She prefers to sit up as the pain
aggravates on lying supine and on eating. On examination, her pulse
rate is 140/min, her temperature is 38.2°C, and there is periumbilical
discoloration. What is the most likely diagnosis?
A. Acute pancreatitis
B. Ruptured ovarian follicle
C. Crohn’s disease
D. Urinary tract infection
E. Pyelonephritis
Perioperative care: Intraoperative care
6. When considering the use of anaesthesia for abdominal aortic
aneurysm (AAA) repair, which of the following statements is incorrect?
A. Aggressive preoperative fluid resuscitation is contraindicated
B. Patients should be anaesthetized after their skin is prepared and draped in the
emergency setting
C. Vasodilators should be given following infrarenal cross clamping, during elective
AAA repair
D. Blood pressure and cardiac output usually increase during aortic cross clamping
E. Patients with aorto-occlusive disease have an exaggerated hypertension and arterial
hypertension during cross-clamping
01_Thrumurthy_Ch01.indd 2 11/5/2012 6:15:59 PM
, QUESTIONS 3
The assessment and management of the surgical patient:
Planning investigations
7. A 31-year-old woman who is due for an elective cholecystectomy presents
to the Emergency Department with sudden-onset right-sided weakness
approximately 2 days after returning to the United Kingdom from
South East Asia. She has no significant past medical history and physical
examination is normal. Chest radiography, electrocardiogram (ECG), and
a computed tomography (CT) head scan are entirely normal. Which one
of the following investigations is most likely to reveal the cause of
her presentation?
A. Carotid Doppler ultrasonography
B. Cerebral angiography
C. Magnetic resonance imaging (MRI) of the head
D. Transoesophageal echocardiography (TOE)
E. Transthoracic echocardiography (TTE)
Basic sciences: Applied anatomy
8. A 45-year-old jockey falls off his horse and sustains a fracture of his
distal tibia involving the ankle joint. After initial resuscitation, a senior
orthopaedic review determines that stability will be best achieved by
external fixation with a quadrilateral frame. This involves a pin placed
in the proximal tibia, linked by rods to another pin which is placed
through the calcaneum. The distal pin is inserted from the medial
aspect of the calcaneum, about an inch (2.5 cm) superior and towards
the toes, away from the heel. Which local nerve is most likely to be
damaged by improper pin placement?
A. Deep fibular (peroneal) nerve
B. Lateral plantar nerve
C. Medial plantar nerve
D. Saphenous nerve
E. Superficial fibular (peroneal) nerve
Basic sciences: Physiology
9. The following are the blood results of a 70-year-old man:
Sodium: 128 mmol/L
Potassium: 4 mmol/L
Urea: 5 mmol/L
Creatinine: 89 mmol/L
Glucose: 13 mmol/L
What is the serum osmolality (mOsmol/kg)?
A. 290
B. 288
C. 282
D. 269
E. 275
01_Thrumurthy_Ch01.indd 3 11/5/2012 6:16:00 PM
, 4 QUESTIONS
Basic sciences: Pathology
10. Which of the following is not true about haemorrhoids?
A. Haemorrhoids are formed by the expansion of the endoanal cushions
B. Portal hypertension may result in haemorrhoids
C. Blood supply is mainly from the superior rectal artery
D. Internal haemorrhoids are lined by columnar and transitional epithelium
E. External haemorrhoids are lined by transitional and squamous epithelium
Common surgical conditions and the subspecialties:
Trauma and orthopaedics
11. An 82-year-old woman, who is normally healthy and independently
mobile, presents to the Emergency Department complaining of severe
hip pain after sustaining a mechanical fall. Plain radiography of her
pelvis reveals an undisplaced intracapsular fracture of the femoral
neck. No signs of osteoarthritis are visible on the radiograph. What is
the best form of treatment for this patient’s hip fracture?
A. Cannulated screw fixation
B. Cemented Thompson’s hemiarthroplasty
C. Dynamic hip screw
D. Non-surgical management
E. Total hip replacement
Common surgical conditions and the subspecialties: Neurology
and neurosurgery
12. A 68-year-old previously healthy woman is brought to the Emergency
Department by ambulance in an unconscious state, after having slipped
on ice and hitting her head on the pavement. After initial resuscitation,
a CT scan of her brain demonstrates a recent right-sided extradural
haematoma. However, it also demonstrates the incidental finding of
a space-occupying lesion in the left temporal lobe with an enhancing
ring around an area of presumed necrosis. The radiologist is concerned
that this incidental finding is suggestive of malignancy. What type of
malignancy is this lesion most likely to represent?
A. Astrocytoma
B. Ependymoma
C. Glioblastoma multiforme
D. Meningioma
E. Oligodendroglioma
01_Thrumurthy_Ch01.indd 4 11/5/2012 6:16:00 PM
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