MRCS part A 8 Jan 13

Discussion in 'MRCS Forum' started by Partha Sarkar, Jan 14, 2013.

  1. 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
    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
    14- Lost sensation side of tongue what nerve
    15- numb lower lip after tooth extraction what 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-Hollisted cells (not sure of the spelling) --> 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 II
    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
    56-patient with winging scapula --> Serratus ant. muscle
  2. 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
    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
  3. 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
    13.
  4. 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 organism
    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 %
  5. 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
    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
  6. 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
  7. 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
  8. 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
  9. 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 ?

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