MRCS part A sep 2013

Discussion in 'MRCS Forum' started by Santosh Jadhav, Sep 16, 2013.

  1. Santosh Jadhav

    Santosh Jadhav Active Member

    Radial head articulates with capitulum
    Radial head enclosed in annular ligament
    Vertebral artery is branch of subclavian artery
    Vertebral artery passes through C6 transverse foramina
    Transpyloric plane at which vertebral level
    IVC pierces diaphragm at T8
    Glucose reabsorp in PCT in kidney
    Upper midline- linea alba
    Pfannestial- rectus sheath
    Gridiron- ext oblique aponeurosis
    Sensitivity=True positive/ Total positive
    ABPI in rest pain, venous ulcer, intermittent claudication n diabetic calcified vessels
    Hyperventillation to decrease ICP
    Trauma: cardiac temponade, ET dislodgement
    Tumour markers: CEA, aFP
    Ant cerebral infarction: spastic lower limb paralysis
    Facial nerve palsy causes: cholesteotoma, .....
    2nd brachial arch-facial muscles

    Acid base problem in heroin intoxication
    Acid base problem is severe bowel infarction
    Acid base problem in DKA

    Nerve lesion in gridiron incision
    Aspiration of liquids after thyroid surgery with laryngoscopy showing no abnormality
    Acute onset dysphagia for solids and then liquids in a patient with oesophageal stent (I was divided between bolus obstruction or stent migration)
    Statistical questions (Absolute risk reduction, NNT, sensitivity, and 2 other really difficult ones, at least for me)
    Tertiary hyperparathyroidism
    Several questions on calcium metabolism
    Palliation for brain mets = dexamathsone
    Palliation for locally invasive pancreatic cancer with constant back pain (I answered nerve block but was divided between TENS and this)
    A painful 2x2 cm lesion behind the nipple in a non-lactating lesion (what was the answer?)
    Rx for a 5cm Grade-3 DCIS (I answered simple mastectomy WITHOUT SLN biopsy).

    Absolute constipation in a depressed patient on anti-depressants
    Constipation after pelvic fracture in an old lady
    Constipation in a youngish patient preceding several weeks of diarrhea and now absolute constipation


    Painless urinary retention after hip surgery in an elderly lady
    Urinary sx with poor stream in a young man with a PMH of possible urethritis

    Bleeding PR in a child with a cherry red lesion
    Bleeding PR in a child preceded by pain and constipation, and now droplets of blood after defecation

    Nerve control of erection (pelvic splanchnic nerves)

    Long term nutritional route for a patient from traumatic brain injury (?PEG)


    Pre-op decision making questions:
    HBV positive lady (go ahead with op but inform all theatre staff)
    Appendectomy in a young girl who is taking OCP (go ahead regardless)
    Open choly in a lady with asymptomatic murmur (what would you do? Would you postpone surgery, pending further Ix)
  2. Santosh Jadhav

    Santosh Jadhav Active Member

    RTA patient with fracture tibia= compartment syndrome
    Chest trauma patient with elevated JVP with bilateral equal air entry= cardiac temponade
    lymphatic drainage of testis, scortum and cervix
    cervical carcinoma cause= HPV
    Aorta bifurcates at L4
    psoas muscle correct statement: origin form T12-L5
    structure anterior to lateral malleolus: perneous longus
    reciprocal of absolute risk reduction: number needed to treat
    anterior relation of rt suprarenal gland: IVC
    jaundice question with scenario: gilbert syndrome and ca head of pancrease
    4yrs child with PR bleeding: juvenile polyp
    constipation+pain+bleeding PR=anal fissure
    first physiological response during hemorrhage: baroreceptors
    healthy man donating 500ml blood causes sweating
    patient on warfarin for post valve replacement: INR 2-3
    child with continuous murmur with hypertension: coarctation of aorta
    autorupture of spleen cause: ?EBV infection
    gynecomastia theme: prostate cancer pt on hormonal therapy-LHRH agonist, 13 yrs with painful gynecomastia-pubertal, liver disease
    48yrs lady with 2cm mass in breast: next best investigation-USG of breast
    palliative care theme: breast ca with sternal mets-radiotherapy, pain control in pancreatic ca-nerve block, intracranial mets-radiotherapy
    T3,T4, TSH, thyroglobulin and calcitonin level given: answers medullary ca thyroid, hypothyroidism, hyperthyroidism, post thyroidectomy with subsequent recurrence and post thyroidectomy without recurrence
    sterilization of: surgical swab, arthoscope and endoscope
    scenario of patient with hyperkalemia cause-spironolactone
    infection theme: clean wound infection due to health care worker-staph aureus, pt on immunosuppressive therapy for UC-candidiasis
    infection with crepitus causative organism- Cl.perfringes
    pt with rt heart border enlarged on CXR-Rt atrium
    PE ECG findings: Twave inversion on V1-3
    post-op pyrexia theme: on 24hr-pulmonary atelactesis, 8th day post op with tender calf-DVT, post gangrenous appendix operation- wound infection
    nerve injury theme: post approach to humerus-radial nerve, medial approach to ankle-saphenous nerve, post approach to hip-sciatic, distal femur approach-tibial nerve
    small saphaneous vein surgery-sural nerve injury
    pale, angular stomatitis with smooth tongue- iron deficiency
    PIVD-nucleus pulposis
    2nd stage of healing, fibroblast needed is- VIt C
    coagulation factor deficiency with liver disease- II,VII,IX and X
    22yrs man with swollen thigh after RTA with externally rotated leg-fracture shaft of femur
    pt underwent medullary ca of thyroid operation- look for urinary catecholamines
    ENT theme: woodcutter with blood mixed nasal discharge-maxillary sinus adenocarcinoma, 11yrs child with tender at left medial epicanthus-empyema of frontal sinus, proptosis with bulging at nasolabial fold with nerve involvement-ethmoidal adenocarcinoma
    ENT theme: h/o pt on longterm ventilation for head injury presented with stridor-tracheal stenosis, 3 yrs child with stridor, drooling of saliva-acute epiglottitis
    graft theme: twin-isograft, nonrelated human donar-allograft, from other site of body-autograft, from different species-xenograft
  3. Santosh Jadhav

    Santosh Jadhav Active Member

    USG distinguish between cystic n solid lesions n in pt aged 48 yrs is best option, mammography is for screening, if pt already had lump then its better to go for USG.

    PEG for patient needing longterm nutritional support as in that question it was mentioned that pt is expected to need long term nutritional support.

    Target INR is 2-3
    If patient hav lt superior venacava then it is called as persistent lt SVC, which drain to coronary sinus

    IV fluid is the best answer on that question as the pt has hypovolemia suggested by hypotension, CVP only 2cmof H2O an decreased UO, which all makes the cause as pre-renal ARF.

    Lymphnode FNAC showing squamous cell carcinoma- organ of origin is tongue
    Ectopic testis- root of the penis
    Scenario with pain abdomen n bleeding PR- presence of ectopic gastric tissue
    Newborn with meconium stain napoy anteriorly-persistent vitellointestinal duct
    Cause of BOO theme: infant with B/L hydronephrosis with Uraemia-PUV, 6mths post urethral discharge patient- urethral sticture

    how to sterilize large swabs ,orthopaedic arthroscopes , and also endoscopes gamma ray?ethylene oxide?gluthardehyde?

    gluthahardeyde for endoscope is correct .
    what are the correct answer to the other 2 :
    arthroscope and large swabs

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